COMMUNITY HEALTH
LEARN THROUGH YOUR COURSE AND FORTIFY ALL YOUR WEAKNESS WITH KNOWLEDGE
Click here to access Unit one Content..
Topic 1: Introduction and Definitions
The determinants of health and well being are the conditions in which people are born, grow, live, work and age. These conditions determine a person's chances of maintaining good health.
Health is influenced by many factors as we shall see in this unit
Community
–defined as a group of interacting people living in a common location. It is often
used to refer to a group that is organized around common values and is
attributed with social cohesion within a shared geographical location,
generally in social units larger than a household.
Health – According to WHO, Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Determinants of Health: The determinants of health and well-being are the conditions in which people are born, grow, live, work and age. These conditions determine a person's chances of maintaining good health.
Click here to access Unit one Content..
Topic 1: Social Determinants
Social Determinants of Health: health is influenced by many factors, which may generally be organized into five broad categories, known as determinants of health and are all interconnected. These are
• Genetics
• Behavior
• Environmental and physical influences
• Medical care
• Social factors
The social factors, encompasses economic and social conditions that influence health. The social determinants impact the health and well-being of people and communities they interact with. Addressing social determinants of health is a primary approach to achieving health equity. Health equity is “when everyone has the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance”. Health equity has also been defined as “the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages that is, different positions in a social hierarchy”. Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities
The World Health Organization has identified 10 social determinants of health:- The Social Gradient
- Stress
- Early Life
- Social Exclusion
- Work
- Unemployment
- Social Support
- Addiction
- Food
- Transport.
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.
The achievement of any State in the promotion and protection of health is of value to all. Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger.
The Government has a responsibility for the health of their peoples which can be fulfilled only by provision of adequate health and social measures.
Click here to access Unit one Content..
Topic 1: Types of Communities
TYPES OF COMMUNITIES
Urban: it’s a large community with many people and big buildings
Suburb a medium sized community near large cities and houses are close together
Rural: a community where houses are far apart, there is smaller number of people in the localities.
Click here to access Unit one Content..
Topic 1: Functions of a Community
FUNCTIONS OF A COMMUNITY
1. Production, distribution and consumption: The community provides its members with the means to make a living. This may be agriculture, industry, or services.
2. Socialization: The community has means by which it instills its norms and values in its members. This may be tradition, modeling, and/or formal education.
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.
4. Social Participation: The community fulfills the need for companionship. This may occur in a neighborhood, church, business, or other group.
5. Mutual Support: The community enables its members to cooperate to accomplish tasks too large or too urgent to be handled by a single person. Supporting a community hospital with tax dollars and donations is an example of people coop
Click here to access Unit one Content..
Topic 1: COMMUNITY HEALTH FEELING, FUNCTIONS AND CONCEPTS
Unit objectives
· Identify sense of community and health
· Describe the functions of a community
· Describe the dimensions of community health
Introduction
Communities may share a sense of place situated in a given geographical area (e.g. country, village, town, etc.) or communication platforms.
Durable relations that extend beyond immediate genealogical ties also define a sense of community that is important to their
- Identity
- Practice
- Role in social institutions (family, home, work, society, or humanity at large)
Community feeling (sense of community)
In 1996 McMillan and Chavis identified four elements of the sense of a community. They include:
1. Membership
This is a feeling of belonging or a feeling of sharing a sense of personal relatedness
2. Influence
Making a difference to a group( mattering) and the group mattering or being important to its members
3. Reinforcement
There should be integration and fulfillment of group needs
4. Shared emotional connection
A sense of feeling among the group members as a single facet
Functions of a community
- Provision of space for housing, shelter, socialization and recreation
- Provision of means and facilities for livelihood
- Provision for an opportunity for employment
- Taking care of socialization and education to its members
- Provision of safety and security for its members through;
- Enforcement of norms
- Legislation formulated by the society
- Provision of opportunities for people to participate and communicate
Dimensions of community health
A community is made up of many but inter-related dimensions. A healthy community is a place to live and where all people can;
- Meet their needs; economic, social , physical , cultural and spiritual
- Work together for the common good
- Participate in creating their future
These dimensions include;
1. Lifelong learning
2. Inclusion
3. Recreational and artistic opportunities
4. Environmental stewardship
5. Infrastructure and services
6. Safety and security
7. Community leadership
8. Economic opportunity
9. Spirituality and wellness.
Dimensions of health
1. Physical health
2. Social health
3. Emotional health
4. Intellectual health
5. Spiritual health
Physical health
It is the condition of the body considering everything from absence of disease, to fitness level. This can be affected by;
- Lifestyle; diet, level of physical activity and behavior
- Human biology; genetics and physiology
- Environment
- Healthcare services
Social health
The ability to interact and form meaningful relationships with others.
Signs of social health
- Having assertive skills rather than aggressive and passive
- Balancing your social and personal time
- Engaging with others in the society
- Adapting in social situation
- Treating others with respect
- Being yourself in all situations
- Developing and maintaining friendship networks
- Having supportive network of family and friends
- Having fun in life
Emotional health
A person’s ability to accept and manage feelings through challenge and change
Characteristics
1. Self-awareness
2. Self-acceptance
3. Emotional agility
4. Strong coping skills
5. Kindness and integrity
6. Living with purpose
7. Managing stress
Intellectual health
Being creative and engaging in mentally stimulating activities
Spiritual health
This is a dimension that focuses on your spiritual. It centers on relationship that supports and enhance your spiritual well-being. These are prayer, meditation and worship erating to accomplish the task of health care.
Click here to access Unit one Content..
Topic 1: Summary
Determinants of Health Status in Community
A community is made up of many but inter-related dimensions. A healthy community is a place to live and where all people can;
- Meet their needs; economic, social , physical , cultural and spiritual
- Work together for the common good
- Participate in creating their future
These dimensions include;
- Lifelong learning
- Inclusion
- Recreational and artistic opportunities
- Environmental stewardship
- Infrastructure and services
- Safety and security
- Community leadership
- Economic opportunity
- Spirituality and wellness.
Dimensions of health
- Physical health
- Social health
- Emotional health
- Intellectual health
- Spiritual health
Physical health
It is the condition of the body considering everything from absence of disease, to fitness level. This can be affected by;
- Lifestyle; diet, level of physical activity and behavior
- Human biology; genetics and physiology
- Environment
- Healthcare services
Social health
The ability to interact and form meaningful relationships with others.
Signs of social health
- Having assertive skills rather than aggressive and passive
- Balancing your social and personal time
- Engaging with others in the society
- Adapting in social situation
- Treating others with respect
- Being yourself in all situations
- Developing and maintaining friendship networks
- Having supportive network of family and friends
- Having fun in life
Emotional health
A person’s ability to accept and manage feelings through challenge and change
Characteristics
• Self-awareness
• Self-acceptance
• Emotional agility
• Strong coping skills
• Kindness and integrity
• Living with purpose
• Managing stress
Intellectual health
Being creative and engaging in mentally stimulating activities
Spiritual health
This is a dimension that focuses on your spiritual. It centers on relationship that supports and enhance your spiritual well-being. These are prayer, meditation and worshipClick here to access Unit one Content..
Topic 1: Further Reading
Reference Material
Further Reading Resources
1. Aggleton, F., Dennison, C & Warwick, I. (2010)2. Promoting health and wellbeing through schools, (1st edition). Routledge Publishers. London UK.
2. Amadan, R. (2010). Planning in Health Promotion Work: An Empowerment Model, London, Routledge. Green, J. & Tones, K. (2010). Health Promtoion: Planning and Strategies, (2nd Ed.). Sage Publications Ltd. Washington D. C, USA
3. Wood. C. H. (2008). Continuing Education for Health Workers Planning District Programmes. Amref, Nairobi. Kenya
4. Holimqvist, M. & Maravelias, C. (2010). Managing Health Organizations Worksite
5. e-resources (content to be added): case studies, case scenarios, simulations, softwares.
Click here to access Unit one Content..
Topic 1: Health Promotion
• By the end of this module the learner should :
• Utilize the methods and channels of health provision of health care
• Share targeted health messages to promote healthful living to patients /clients
Click here to access Unit one Content..
Topic 1: Health Promotion Cont'd
TERMS AND CONCEPTS
Health
A broad concept with various definitions
Ø A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO,1946)
Ø Its holistic and includes different dimension
Physical health- fitness, not being ill, absence of signs and symptoms
Mental health-positive sense of purpose and an underlying belief in one’s own worth e.g. feeling good, feeling able to cope
Emotional health- ability to feel, recognize and give a voice to feelings and to develop and sustain relationships e.g. feeling loved
Social health- sense of having support available from family and friends
Spiritual health- the recognition and ability to put into practice moral or religious principles or beliefs and the feeling of having a purpose in life.
Sexual health- the acceptance and ability to achieve a satisfactory expression of one’s sexualityClick here to access Unit one Content..
Topic 1: Definition of health promotion –Ottawa Charter and WHO
It is the process of enabling people to increase control over and improve their health. (Ottawa H.P. Charter).
Principles of Ottawa Charter
© Building healthy public policy.
© Creating supportive environments.
© Strengthening community action.
© Developing personal skills.
© Re-orienting health care services toward prevention of illness and promotion of health.
OTTAWA CHARTER
The first International Conference on Health Promotion was held in Ottawa, Canada in November 1986. The aim of the conference was action to achieve Health for all by the year 2000 and beyond.
ü Strategies for health promotion-Ottawa charter
It incorporates five key action areas in Health Promotion (build healthy public policy, create supportive environments for health, strengthen community action for health, develop personal skills, and re-orient health services) and three basic HP strategies (to enable, mediate, and advocate).
Aim of Ottawa Charter
The aim of the conference was action to achieve Health for all by the year 2000 and beyond.
Elements of good governance for health
To maximize the success and legitimacy of the public health law reform process, countries should integrate the following six principles into the law reform process:
Eight Elements of Good Governance
• Rule of Law. Good governance requires fair legal frameworks that are enforced by an impartial regulatory body, for the full protection of stakeholders.
• Transparency. ...
• Responsiveness. ...
• Consensus Oriented. ...
• Equity and Inclusiveness. ...
• Effectiveness and Efficiency. ...
• Accountability. ...
• Participation.
Click here to access Unit one Content..
Topic 1: Healthy Cities
• A healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential.”
• The goal is to maximize disease prevention via a "whole system" approach, which integrates multi-disciplinary action across risk factors. The key principles of all Healthy Settings include community participation, partnership, empowerment and equity.
Initiated by WHO in 1986, The Healthy Cities programme is the best-known example of a successful Healthy Settings approach
What is a Healthy City?
A Healthy City aims to:
• to create a health-supportive environment,
• to achieve a good quality of life,
• to provide basic sanitation and hygiene needs,
• to supply access to health care.
• Being a Healthy City depends not on current health infrastructure, rather upon a commitment to improve a city's environs and a willingness to forge the necessary connections in political, economic, and social arenas.
The 2030 Agenda for Sustainable Development: in 2015, the UN re-emphasized the interconnected nature of global development efforts by setting 17 Sustainable Development Goals (SDGs). Health promotion efforts, grounded in a health cities approach, can contribute to achieving these goals, including SDG 11: “make cities and human settlements inclusive, safe, resilient and sustainable”.
Read more on the 17 sustainable development goals(SDGs)
Click here to access Unit one Content..
Topic 1: Methods of health promotions
- Audio .
- women and male groups
- Visual aids
- Role play
- Songs
- Barazas
- Schools
- Youth groups
• Community dialogue
Community dialogue is a forum that draws participants from different sections of a community and creates the opportunity for exchanging information and perspectives, clarifying viewpoints, and developing solutions to issues of interest to the community.
• Steps of an organized community dialogue
Steps in Organizing a Dialogue
ü Think about your community. ...
ü Think about your goals.
ü Think about who should be included.
ü Think about what format to use.
ü What's going on in our community that a dialogue would address? ...
ü Who should be involved?
ü Look for other groups with which to partner.
Click here to access Unit one Content..
Topic One: Summary
Steps in Organizing a Dialogue
ü Think about your community. ...
ü Think about your goals.
ü Think about who should be included.
ü Think about what format to use.
ü What's going on in our community that a dialogue would address? ...
ü Who should be involved?
ü Look for other groups with which to partner.
Click here to access Unit one Content..
Topic One: Further Reading
Click here to access Unit one Content..
Topic Two: Health education
Health education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes.
• Aims and objectives of health education
• Health education is one of the factors of development because it contributes to: increase the efficacy of health services, curative as well as preventive
1. To improve productivity by reducing occupational diseases and accidents;
2. To change the social climate of communities by getting the people to participate in finding solutions to their own health
Principles of health education
- Interest.
- Participation.
- Proceed from known to unknown.
- Comprehension.
- Reinforcement by repetition.
6. Motivation
7. Learning by doing
8. People, facts and media.
9. Good human relations
10. Leaders
• Cognitive Model – “Telling people”
– Health
– Illness
– Ways to improving & protecting health & efficient use of the delivery system.
• Motivation Model:
– Reluctance or inability of people to translate information received into practice.
– Shortcomings:
• Other elements needed
• = social & economic factors
· Social Intervention Model:
Pre-requisites for health:
– Income
– Food
– Shelter
– Education
– Peace
– Justice
– Equity
Click here to access Unit one Content..
Topic Two: Theories of health education
• Theory of Reasoned Action/Planned Behavior
Two closely associated theories – The Theory of Reasoned Action and the Theory of Planned Behavior – suggest that a person's health behavior is determined by their intention to perform a behavior.
A person's intention to perform a behavior (behavioral intention) is predicted by 1) a person's attitude toward the behavior, and 2) subjective norms regarding the behavior. Subjective norms are the result of social and environmental surroundings and a person's perceived control over the behavior.
Generally, positive attitude and positive subjective norms result in greater perceived control and increase the likelihood of intentions governing changes in behavior.
• cognitive theory
The Cognitive Learning Theory: is a broad theory used to explain the mental processes and how they are influenced by both internal and external factors in order to produce learning in an individual. The theory is credited to Educational psychologist Jean Piaget.
An individual's decision to engage in a particular behavior is based on the outcomes the individual expects will come as a result of performing the behavior. Developed by Martin Fishbein and Icek Ajzen in 1967
• Humanist theory
The humanistic perspective is an approach to psychology that emphasizes empathy and stresses the good in human behavior. ... In counseling and therapy, this approach allows an psychologist to focus on ways to help improve an individual's self-image or self-actualization - the things that make them feel worthwhile.
Click here to access Unit one Content..
Topic Two: Approaches to health education
Behavioural change
The behaviour change approach is used to bring about changes in an individual’s thinking or perception. You should be able to use this method to change the behaviour of individuals within your community and help them make their own health-related decisions
This approach can be applied using locally available methods and media such as leaflets and posters.
Self empowerment
• It’s important to remember that self-empowerment is rooted in awareness and understanding that people can act to change their own lives on their own behalf . environment.
• Using the self-empowerment approach you can provide the tools they will need to make their own choices about their health and increase their control over their physical, social and psychological
• It is a process which empowers families and communities to improve their quality of life, and achieve and maintain health and wellness.
It emphasizes not only prevention of disease but the promotion of positive good healthClick here to access Unit one Content..
Topic Two: Steps in carrying out a health programme
• STEP 1: MANAGE THE PLANNING PROCESS. ...
• STEP 2: CONDUCT A SITUATIONAL ASSESSMENT. ...
• STEP 3: IDENTIFY GOALS, POPULATIONS OF INTEREST, OUTCOMES.
• STEP 4: IDENTIFY STRATEGIES, ACTIVITIES, OUTPUTS, PROCESS.
• STEP 5: DEVELOP INDICATORS. ...
• STEP 6: REVIEW THE PROGRAM PLAN.
Methods of health education
• Health talks
• Group discussions
• Lecture
• Buzz groups
• Demonstrations
• Roleplays
• Drama
• Traditinal means of communication
Click here to access Unit one Content..
Topic Two: Planning for a health education
Health Program Planning focuses on assessment, analysis, and planning to help you to design and implement public health strategies, with a high likelihood of achieving desired objectives.
Before you can begin planning your health education activities, you need to have a clear understanding of what planning means. Planning is the process of making thoughtful and systematic decisions about what needs to be done, how it has to be done, by whom, and with what resources. Planning is central to health education and health promotion activities
Key questions to ask when planning
• What will be done?
• When will it be done?
• Where will it be done?
• Who will do it?
• What resources are required?
The purpose of planning in health education
• There are several benefits to planning your activities. Firstly, planning enables you to match your resources to the problem you intend to solve (Figure 12.2). Secondly, planning helps you to use resources more efficiently so you can ensure the best use of scarce resources.
• Thirdly, it can help avoid duplication of activities. For example, you wouldn’t offer health education to households on the same topic at every visit.
• Fourthly, planning helps you prioritise needs and activities.
• This is useful because your community may have a lot of problems, but not the resources or the capacity to solve all these problems at the same time.
• Finally, planning enables you to think about how to develop the best methods with which to solve a problem.
Six principles of planning in health education
- It is important that plans are made with the needs and context of the community in mind..
- Consider the basic needs and interests of the community..
- Plan with the people involved in the implementation of an activity..
4. Identify and use all relevant community resources.
5. Planning should be flexible, not rigid..
6. The planned activity should be achievable, and take into consideration the financial, personnel, and time constraints on the resources you have available..
NB:You should not plan unachievable activities
• STEPS IN PLANNING
- Assess needs
- Identify and prioritise
- Set goals and objectives
- Develop strategies
- Implement
- Monitor and evaluate
Needs assessment is the process of identifying and understanding the health problems of the community, and their possible causes . The problems are then analyzed so that priorities can be set for any necessary interventions. The information you collect during a needs assessment will serve as a baseline for monitoring and evaluation at a later stage.
Click here to access Unit one Content..
Topic Two: Behavioral Change Communication
BCC), SBCC is the strategic use of communication approaches to promote changes in knowledge, attitudes, norms, beliefs and behaviors. ... SBCC is grounded in theory and is evidence-based.
• Steps in BCC
Step 1:unaware
Step2: informed/aware
Step 3:Concerned
Step 4:Knowledge and skilled
Step 5:Motivated to change
Step 6:Trial change of new behavior
Step 7:Mantainance /adoption of new behavior
Factors affecting behavior change
ü Abilities.
ü Gender.
ü Race and culture.
ü Attribution.
ü Perception.
ü Attitude.
• The health belief model (HBM) is a social psychological health behavior change model developed to explain and predict health-related behaviours, particularly in regard to the uptake of health services. The HBM was developed in the 1950s by social psychologists at the U.S. Public Health Service and remains one of the best known and most widely used theories in health behavior research .
• The HBM suggests that people's beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behavior. A stimulus or cue to action, must also be present in order to trigger the health-promoting behavior.
• The HBM predicts that individuals who perceive that they are susceptible to a particular health problem will engage in behaviors to reduce their risk of developing the health problem.
• Individuals with low perceived susceptibility may deny that they are at risk for contracting a particular illness
• Others may acknowledge the possibility that they could develop the illness, but believe it is unlikely.
• Individuals who believe they are at low risk of developing an illness are more likely to engage in unhealthy, or risky, behaviors
Individuals who perceive a high risk that they will be personally affected by a particular health problem are more likely to engage in behaviors to decrease their risk of developing the conditionClick here to access Unit one Content..
Topic Two: Advocacy in health promotion
• Advocacy is a key health promotion activity for overcoming major barriers to public health and occupational health.
• The barriers addressed by advocacy are poor living and working conditions, rather than individual or behavioral barriers.
• Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public.
• Health advocates are best suited to address the challenge of patient-centered care in our complex healthcare system.
The five principles of health promotion
(1) A broad and positive health concept
(2) Participation and involvement
(3) Action and action competence
(4) A settings perspective and
(5) Equity in health.
INFORMATION, EDUCATION and COMMUNICATION
• Information, Education and Communication (IEC) Materials and. Events.
• Introduction. Effective Information, Education and Communication (IEC) materials are an important component of the comprehensive HIV education campaign you will implement with the help of The Road to Good Health toolkit.
• Effective Information, Education and Communication (IEC) materials are an important .
• Effective materials are clear, communicate specific messages, and are easily remembered
What is Health Promotion all about? Cont….
• It is a positive concept emphasizing personal, social, political and institutional resources, as well as physical capacities.
• Health
promotion is any combination of health, education, economic, political,
spiritual or organizational initiative designed to bring about positive
attitudinal, behavioral, social or environmental changes conducive to improving
the health of populations.
• Health promotion is directed towards action on the determinants or causes of health
• Health promotion, therefore, requires a close co-operation of sectors beyond health services, reflecting the diversity of conditions which influence health.
• Government at both local and national levels has a unique responsibility to act appropriately and in a timely way to ensure that the ‘total’ environment, which is beyond the control of individuals and groups, is conducive to health.
Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health.
• Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health.
• Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior and create environments that support good health practices. Of the three, supportive environments will probably have the greatest impact in producing lasting change". (American Journal of Health Promotion, 1989)
Determinants of Health
q Life style (50%)
q Environment (cultural, economic, social and physical conditions of life) (20%)
q Genetic background (20%)
q Health care system (10%)
Click here to access Unit one Content..
Topic Two: Components of Health Promotion
- Health protection implemented by public health policy
- Health education
- Intervention programmes
Health Promotion Important Policy Documents
q Ottawa Charter (1986)
q Health for All 21 and WHO key strategies
q European Health Policy ( 1999)
q National Health Programme (1995)
q National Environment and Health Action Plan of CR (1998)
q Law No. 258/2000 on Public Health Protection (2000)
q Longterm Programme on Improving Health Status of Inhabitants of CR – Health for All 21 (2002)
WHO - Key strategies of health promotion
q Strategy on environment and children health (2002)
q Global strategy on nutrition, physical activity and health (2003)
q Framework convention on tobacco control (2003)
q European action plan against alcohol (2003)
q Declaration on mental health for Europe (2005)
National Health Programme
Goals:
q Increase the knowledge of people on healthy life style
q Increase the knowledge of people on possibilities of disease prevention
Create coalitions for health promotion in the society
Click here to access Unit one Content..
Topic Two: PRINCIPLES OF HEALTH PROMOTION
v Empowerment – enabling people to gain greater control over decisions and actions affecting them.
v Participation- where people take an active part in decision making.
v Holistic –taking account of separate influences on health and the interaction of these dimensions
v Intersectoral collaboration- working in partnership with other relevant agencies/organizations
v Equitability- ensuring fairness of outcomes for service users
v Sustainability- ensuring that the outcomes of health promotion are long lasting
v Multi-strategy- working on a number of strategy areas such as programs, policy etc.
Health Promotion includes …
• Promoting healthy lifestyles.
• Getting people involved in their own health care.
• Creating an environment that makes it possible to live a healthy life.
• Recognition of lifestyle diseases as major causes of illness and death.
• Strengthening community participation.
• Examples of preventable health problems related to lifestyle
• Chronic non-communicable diseases such as diabetes and hypertension. These are major causes of illness and death. They are related to…
– Overweight and obesity.
– Unhealthy diet.
– Insufficient physical activity.
• HIV/AIDS is related to unsafe sexual lifestyle, and causes many deaths
Intersectoral approach
Health Promotion brings together many sectors to work towards the achievement and maintenance of health and wellness.
– The Health sector alone cannot achieve a healthy society.
– All sectors, both government and non-government, need to work together.
– Health Promotion can provide the link between the various sectors.
– Within Health the various disciplines also need to work together towards wellness.
• Some non-health sectors with an input into Health Promotion…
• Education/ schools
• Agriculture
• Community Services
• Sport
• Media
• Non-Governmental Organizations (NGO’s)
• Community groups
• Youth
• Private sector
Other Health sectors with an input into Health Promotion
• Clinical medicine
• Environmental Health
• Family Health(c/med)
• Nutrition
• Community nursing
• Mental Health
• Dental
• Epidemiology
• Hospital (secondary) care
Some other sectors which are important
v Legal
v Public Works
v Housing
v Water Authority
v Christian Council
Alternative medicine
Formulating healthy public policy
• Promotes healthy policies in all sectors , eg healthy workplaces, schools, homes, buildings, villages and communities.
• Health aspect should be thought of and included in the policies of the various sectors.
• Health Policies should also emphasize the prevention and promotion.
• Reorienting health services
Since lifestyle is linked to many of today’s health problems, prevention and promotion should decrease the burden on secondary (curative) health care.
- Greater emphasis and resources placed on health promotion and primary health care.
– Less emphasis on purchase of high tech equipment for secondary health care.
– Equity in health care.
• Empowering communities to achieve well-being
• Involvement of the community in health decisions, a multispectral and participatory approach.
• Provide communities with the information and tools to take actions to improve health and well-being.
• Creating supportive environments
• Healthy physical, social and economic environment.
• All development activities should aim for a healthy environment – healthy buildings, roads, workplaces, homes, surroundings and schools.
• Developing /increasing personal health skills
• Information and education for personal and family health.
• Take account of values, beliefs and customs of the community.
• Continuous process at all stages of life.
• Guided and supported in developing skills (not imposed on them).
• Build on existing knowledge and attitudes.
• Building alliances with special emphasis on the media
• Media key players, influence on health of people.
• Partnership with media ensures their collaboration and that correct information is passed on.
• Free flow of information both ways, on matters vital to health.
Click here to access Unit one Content..
Topic Two: Health Promotion: key developments
• WHO definition of health (1948, 1998)
• Declaration of Alma Ata (1978)
- blueprint for PHC
- ‘Health For All by the Year 2000’
• Ottawa Charter (1986)
• Laid down principles of HP still followed today
• Jakarta Declaration on Health Promotion into the 21st Century (1997)
• Bancock Charter (OC revisited in 2005)
10 Key Action Areas for Health Promotion (Ottawa Charter and Jakarta Declaration)
- Build healthy public policy
- Create supportive environments
- Strengthen community action
- Develop personal skills
- Reorient health services towards primary health health care
- Promote social responsibility for health
7.Increase investment for health development to address social inequalities leading to poor health
8.Consolidate and expand partnerships for health
9.Strengthen communities and increase community capacity to empower the individual
Click here to access Unit one Content..
Topic Two: IMPORTANT AREAS FOR CONSIDERATION IN HEALTH PROMOTION
• COMMUNITY SKILLS:
Some of the skills needed include those that will:
• Strengthen community action
• Develop personal skills
• Re-orient health services
• .Strengthen community action
Enable and empower communities, provide resources so they actively participate in health decisions which leads to better health outcomes. They can apply those skills to other situations themselves need to determine what their needs are and how they best can be met.
• Community development.
• Capacity building.
Reorient heath services
Aim for a balance between health promotion and treatment services?
• How can we work with other sectors whose work impacts on health?
• Include health promotion in job descriptions, a designated role.
• Develop Personal Skills (the one we are most familiar with)
• Provide information, education and skills.
• Those who gain skills are often the least likely to need them
• So be creative and reach others e.g. display or health screening or other activity – those who you need to reach may not attend/be able to read etc
• Build skills at all levels - support others to work in a health promoting way.
• The health promoting way of working……..
• Work with the community to identify priorities
• Support local initiatives
• Find out what is already happening
• Find out what people know and what they think is important
• Share information
• Assist with skills development
• Assist with research & information collection
• Help to plan community action
• Provide or assist to locate resources if needed
Click here to access Unit one Content..
Topic 2: Further Reading
Essentials of community health by Jaypee
Community health –IRC wash
Community health –Third edition –Chris wood
Community medicine manual- Rajvir BhalwarClick here to access Unit one Content..
Topic One: Objectives
- Define PHC
- Outline the concepts and principles of primary Health care(PHC) in Kenya
- Explain the organisation of primary health care in Kenya.
- Assess the primary health needs in a community
- Initiate and implement co-ordinated primary health care activities.
- Describe the strategies of primary health care
- Healthcare services in Kenya
- In Kenya, health services are organised based on:
- Type – Promotive, Preventive, Curative; and Rehabilitative
- Cohorts (Target group )- Cohort 1,2,3,4,5,6
- Tiers (Level)- Community, Primary health care, Secondary health care and Tertiary health care
Click here to access Unit one Content..
Topic 1: Levels of Health care delivery
Primary health care
l The “first” level of contact between the individual and the health system.
l Essential health care (PHC) is provided.
l A majority of prevailing health problems can be satisfactorily managed.
l The closest to the people.
l Provided by the primary health centers.(Health Centers/Dispensaries)
Secondary health care
l More complex problems are dealt with.
l Comprises curative services
l Provided by the County level /Sub county
l 1st referral level
Tertiary health care
• Offers super-specialist care
• Provided by regional/central level institution.
• Provide training programs
• National Teaching and Referral Hospitals
• Medical care versus Health care
• Medical care: personal services provided by physicians
• Health care: services provided to individuals or communities by health service professionals for purpose of
§ Promoting
§ Maintaining
§ Monitoring
Restoring healthClick here to access Unit one Content..
Topic 1: Determinants of Health
All people, everywhere, deserve the right care, right in their community. This is the fundamental premise of primary health care.
Primary health care (PHC) addresses the majority of a person’s health needs throughout their lifetime. This includes physical, mental and social well-being and it is people-centred rather than disease-centred. PHC is a whole-of-society approach that includes health promotion, disease prevention, treatment, rehabilitation and palliative care.
At least half of the world’s people still lack some or all essential health services.
PHC focuses on the person rather than the disease, it is an approach that moves away from overspecialization. In PHC, the goal is to work through multidisciplinary teams with strong referral systems to secondary and tertiary care when needed.
PHC goes beyond providing health care services to individuals. It is a whole-of-society approach that seeks to address the broader determinants of health, such as community-level disease-prevention efforts, and to empower individuals, families and communities to get involved in their own health.
“Primary care” is a subset of PHC and refers to essential, first-contact care provided in a community setting.
A primary health care approach includes three components:
- Meeting people’s health needs throughout their lives;
Addressing the broader determinants of health through multisectoral policy and action;
Empowering individuals, families and communities to take charge of their own health. PHC addresses not only individual and family health needs, but also the broader issue of public health and the needs of defined populations.
PHC it is about how best to provide health care and services to everyone, everywhere in the community as well as care through the community is the most efficient and effective way to achieve health for all.
The principles of PHC were first outlined in the Declaration of Alma-Ata in 1978, a seminal milestone in global health. Forty years later, global leaders ratified the Declaration of Astana at the Global Conference on Primary Health Care which took place in Astana, Kazakhstan in October 2018.
In1981 WHO determined that HFA by 2000 could have been best achieved through primary health care i.e. ATTAINMENT OF A LEVEL OF HEALTH THAT WILL ENABLE EVERY INDIVIDUAL LEAD A SOCIALLY AND ECONOMICALLY PRODUCTIVE LIFE
Alma-Ata declaration
In 1978, leaders from around the world gathered in Alma-Ata, Kazakhstan, for what would prove to be a seminal moment in global health. The Declaration of Alma-Ata was the first to call for urgent and effective national and international action to develop and implement primary health care throughout the world.”
The international conference on primary care reaffirmed HFA as social goal of the governments.
Primary health care (PHC) became a core policy for the World Health Organization with the Alma-Ata Declaration in 1978 and the ‘Health-for-All by the Year 2000’ Program.
The commitment to global improvements in health, especially for the most disadvantaged populations, was renewed in 1998 by the World Health Assembly. This led to the ‘Health-for-All for the twenty-first Century’ policy and program, within which the commitment to PHC development is restated.
Declaration of Astana
Forty years later, leaders and stakeholders representing government, the private sector, and civil society returned to Kazakhstan. The Global Conference on Primary Health Care, which took place in Astana in October 2018, reaffirmed primary health care as the most effective and efficient approach to achieve universal health coverage and the Sustainable Development Goals.
Based on a bold vision, the 2018 Declaration of Astana centers around 4 commitments:
1. Making bold political choices for health across all sectors;
2. Building sustainable primary health care – adapted to each country’s local context;
3. Empowering individuals and communities;
4. Aligning stakeholder support to national policies.
The commitment to global improvements in health, especially for the most disadvantaged populations, was renewed in 1998 by the World Health Assembly. This led to the ‘Health-for-All for the twenty-first Century’ policy and program, within which the commitment to PHC development is restated.
Moving to a primary health care approach helps to strengthen health systems and is the most effective way to achieve universal health coverage.
The PHC Operational Framework outlines a series of levers that can be actioned to align health systems according to a PHC approach. These include:
- Political commitment and leadership;
Governance and policy frameworks;
Adequate funding and equitable allocation of resources;
Engagement of community and other stakeholders to jointly define problems and solutions and prioritize actions;
Models of care that prioritize primary care and public health functions
Ensuring the delivery of high-quality and safe health care services - Engagement with private sector providers;
- PHC workforce;
Physical infrastructure and appropriate medicines, products and technologies;
Digital technologies;
Purchasing and payment systems;
PHC-oriented research;
Monitoring and evaluation The Operational Framework is currently undergoing review by Member States and a final version is anticipated to be presented for endorsement in 2020.
Click here to access Unit one Content..
Topic 1: What is Primary Health Care?
- PHC is essential health care that is a socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximises community and individual self-reliance and participation and involves collaboration with other sectors. It includes the following:
- Ø health promotion
- Ø illness prevention
- Ø care of the sick
- Ø advocacy
- Ø community development
- PRIMARY HEALTH CARE (Broader Definition)
- • Definition of PHC by Alma Ata international conference of 1978.
- “It is the essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at each stage of their development, in the spirit of self-reliance and self-determination”
- Primary Health Care
- • It is the first level of contact with the health system to promote health, prevent illness, care for common illnesses, and manage ongoing health problems. It includes:
- • Primary Care (physicians Clinical Officers & nurses)
- • Health promotion, illness prevention;
- • Health maintenance & home support;
- • Community rehabilitation;
- • Pre-hospital emergency medical services; &
- • Coordination and referral to other areas of health care.
- • Services
are generally provided in the community
- • Some services are also provided in hospitals
- • Primary Health Care is different in each community depending upon:
- • Needs of the residents;
- • Availability of health care providers;
- • The communities geographic location; &
- • Proximity to other health care services in the area.
- Primary Health Care extends beyond the traditional health sector and includes all human services which play a part in addressing the inter-related determinants of health.
Click here to access Unit one Content..
Topic 1: Principles of PHC
- PHC based on the following principles :
- Social equity-equitable distribution
- Decentralization- nation-wide coverage
- Self-reliance
- Inter-sectoral coordination
- Community participation-people’s involvement in the planning and implementation of health programs
- Accessibility(physical access, affordability and acceptability)
- Health promotion and disease prevention
- Effectiveness
- Efficiency
- Integration of health programmes
- Apropriate technology
- Equity
- - a fair distribution and access of health resources to all population groups.
- - this principle is taken into account when deciding on the location of new health facilities, locating outreach service points, introduction of new health programs or any charges for services
- Decentralization
- - this is the transfer of authority for planning, decision making and management from a higher to a lower level such as the central government headquarter(ministries) to the districts.
- Intersectorial
action and coordination
- - is essential for many health and health related activities e.g. water, sanitation, housing, food supplies and education
- Education, hosing, agriculture,ect….
- Community participation
- - only when a community fully understands and is committed to a program will that program stand a chance of success and sustainability.
- Financial and man power wise
- Let them promote their own health
- Accessibility
- - ability to utilize a service either by its physical availability, cost affordability or social acceptability
- - accessibility to a health facility depends on locating it near where people live, improving transport and arranging appropriate opening hours, assuring acceptability to the community and a welcoming attitude from the staff and making it affordable.
- Health
promotion and disease prevention
- - health promotion is a broad concept that includes behavior change in relation to many activities such as nutrition, environment and recreation
- - prevention implies identification of ‘’at-risk’’ and implementing appropriate preventive measures
- l Principles cont;
- Effectiveness
- - the technologies and strategies used in health care do work, that is, they reduce risk and prevent or cure disease
- Efficiency
- - the methods used to achieve a given result use the minimum resources- facilities, manpower, money and time required to the job
- Integration of health programs
- - the individual patient, family and community must understand how to use the health care system when they need it.
- - this means that the system should be friendly and accessible.
- Appropriate
technology
- - new developments in vaccines and immunization techniques, drugs etc should be included.
- According to need not on demand
Click here to access Unit one Content..
Topic 1: PHC Activities
- “Reflect and evolve from the economic conditions and socio-cultural and political characteristics of the country and its communities, and be based on the application of the relevant results of social, biomedical and health services research and public health experience”
1. PHC should:
2. “Address the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly”
3. “Involve, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works,
4. “Promote maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develop through appropriate education the ability of communities to participate”
5. “Be sustained by integrated, functional and mutually-supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need”
6. “Rely, at local and referral levels, on health workers, including physicians,Clinicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.”
Core Activities for PHC
There is a set of CORE ACTIVITIES, which were normally defined nationally or locally.
These care activities are the ELEMENTS OF PHC. According to the 1978 Declaration of Alma-Ata proposed that these activities should include:
Click here to access Unit one Content..
Topic 1: ELEMENTS OF PRIMARY HEATH CARE
- Health Education concerning prevailing health problems and the methods of preventing an controlling them
- Promotion of food supply and proper nutrition
- An adequate Safe water Supply and basic sanitation
- Maternal and child health care including FP
- Immunization against major infections diseases
- Prevention and control local endemic diseases
- Appropriate treatment of common diseases and injuries
- Provision of essential drugs and basic laboratory services
- EXTENDED ELEMENTS OF PHC
- © Expanded options of immunization
- © Reproductive health needs
- © Provision of essential technologies for health
- © Prevention and control of non communicable diseases
- © Food safety and provision of selected food supplements.
- © Physical handicaps
- © Health and social care of the elderly
- © Training of health guides, health workers and health assistants.
- © Referral services
- N/B-Countries have added more elements depending on their specific situation e.g. Kenya have added mental health, dental health and more recently HIV/AIDS
Click here to access Unit one Content..
Topic 1: Selective PHC activities
Selective PHC activities- (GOBI-FFF)
Growth monitoring
Oral rehydration
Breast feeding
Immunization
Supplementary feeding
Family planning
Female literacy
Click here to access Unit one Content..
Topic 1: The Basic Requirements for Sound PHC
- The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
- Appropriateness
- Availability
- Adequacy
- Accessibility
- Acceptability
- Affordability
- Assessability
- Accountability
- Completeness
- Comprehensiveness
- Continuity
- Appropriateness
- Ø Whether the service is needed at all in relation to essential human needs, priorities and policies.
- Ø The service has to be properly selected and carried out by trained personnel in the proper way.
- Adequacy
- Ø The service proportionate to requirement.
- Ø Sufficient volume of care to meet the need and demand of a community
- Affordability
- Ø The cost should be within the means and resources of the individual and the country.
- Accessibility
- Ø Reachable, convenient services
- Ø Geographic, economic, cultural accessibility
- Acceptability
- Ø Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.
- Availability
- Ø Availability of medical care means that care can be obtained whenever people need it.
- Assessability
- Ø Assessebility means that medical care can be readily evaluated.
- Accountability
- Ø Accountability implies the feasibility of regular review of financial records by certified public accountants.
- Comprehensiveness
- Ø Comprehensiveness of care means that care is provided for all types of health problems.
- Completeness
- Ø Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.
- Continuity
- Ø Continuity of care requires that the management of a patient’s care over time be coordinated among providers.
Click here to access Unit one Content..
Topic 1: Benefits/Importance of PHC
- • PHC focuses on keeping people healthy & addressing illness early so as to increase probability of cure;
- • PHC is client focused;
- • Individuals have access to appropriate care;
- • Services are matched to community needs;
- • Targeted services will have a positive impact on the utilization of health and social services;
- • Healthy communities with healthy people contribute to a vibrant & stable economy.
- It has also been proven that health systems with a PHC-based foundation result in improved clinical outcomes, increased efficiency, better quality of care and enhanced patient satisfaction. Strong primary care is the basis for a strong health care system
- The best systems are the ones with strong primary care, e.g., UK, Netherlands
- Romano report devoted a whole chapter to primary care; saw it as the basis of a transformed system
- Other important attributes of primary care
- First contact
- Accessibility
- Continuity
- Case-management (responsibility for coordinating all the care that a person needs)
- Assignment 2
- The primary healthcare reforms key to achieving Universal Health Coverage In Kenya
- KAPH/KHSSP 1& 2
- Misconception about PHC
- PHC only provides “basic” care- PHC provides essential care that cover the majority of a person’s health needs throughout their lives
- PHC is about maternal and child health – PHC is about health at all ages and involves prevention, health promotion, treatment, rehabilitation, and palliation.
- PHC is “cheap” health care for the poor; PHC is based in the community and it is the only health care available to poor or marginalized communities
Click here to access Unit one Content..
Topic 1: Strategies of PHC
1.Reducing excess mortality of poor marginalized populations:
PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will directly impact on the major causes of mortality, morbidity and disability for those populations.
2. Reducing the leading risk factors to human health:
PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major determinants of health outcomes for local populations.
3. Developing Sustainable Health Systems:
PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served.
4. Developing an enabling policy and institutional environment:
PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development policy.
A 20th Century Model of Primary Care Will Not Meet the Demands of 21st Century Health Care
Obstacles to the implementation of the PHC strategy
Misinterpretation of the PHC concept
Common misconception of the role and benefits of PHC and that it is a 2nd rate health care for the poor.
Selective PHC strategies
Lack of political will-Political will has advanced greatly with the adoption of the Declaration of Astana.
Centralized planning and management
PHC has been neglected in many countries in favour of a disease-specific approach under investment,
Changing values and rising expectations
Adapting to new health challenges
Reasons for slow progress
o Insufficient political commitment
o Failure to achieve equity in access to all PHC components
o The continuing low status of women
Slow socio- economic development
o Difficulty in achieving inter sectorial action for Health
o Unbalanced distribution of resources
o Widespread inequity of health promotion efforts
o Weak health information systems and lack of baseline data
o Rapid demographic and epidemiological changes
o Inappropriate use and allocation of resources for high cost technology
o Natural and man made disasters
Click here to access Unit one Content..
Topic 1: HOW EXPERIENCE HAS SHIFTED THE PHC MOVEMENT
- Extended access to a basic package of health interventions
- Concentration on MCH
- Focus on small number of selected diseases
- Transformation and regulation of existing health systems aiming for universal access
- Dealing with the health of everyone
- A comprehensive response to peoples’s expectations
- Improvement of hygiene, water and sanitation
- Simple technology for volunteer, community health workers
- Participation as the mobilization of local resources
- Government funded and delivered services, with a centralized top down management
- Promotion of health lifestyles and mitigation of health effects of social and environmental hazards
- Teams of health workers facilitating access to and appropriate technology
- Institutionalized participation of society in policy dialogue and accountability mechanisms
- Government funded and delivered services with a centralized
- Management of growing scarcity and downsizing
- Bilateral aid and technical assistance
- Primary care as the antithesis of the hospital
- PHC is cheap and requires only a modest investment
- Guiding the growth of resources for health towards universal coverage
- Global solidarity and joint learning
- Primary care as coordinator of a comprehensive response
- PHC is not cheap. It requires considerable investment .
Click here to access Unit one Content..
Topic 1: COMMON SHORTCOMINGS (PROBLEMS) OF HEALTH CARE DELIVERY
- INVERSE CARE (Urban oriented)
- IMPOVERISHING CARE
- FRAGMENTED AND FRAGMENTING CARE
- UNSAFE CARE
- MISDIRECTED CARE
- Curative in nature
- Accessible to small part of people
- Patients Need a Good Home and a Good Neighborhood
Click here to access Unit one Content..
Topic 1: PHC REFORMS
- FOUR SETS OF PHC REFORMS
- UNIVERSAL COVERAGE REFORMS
- SERVICE DELIVERY REFORMS
- PUBLIC POLICY REFORMS
- LEADERSHIP REFORMS
- The Primary Care Reform Compact
- To Payers, purchasers, the public:
- Invest a greater share of health care resources in primary care to strengthen the primary care workforce and enhance primary care performance
- To Primary care physicians and clinicians:
- Embrace innovation, new models of care, and greater patient-centeredness in return for more investment in primary care
- Primary Health Care Reform
- Building Blocks of high performing primary care practices Moving towards PHC
- Primary health care is important because it is the foundation of a strong health system. It leads to more equitable health across the community and leads to greater patient and health worker satisfaction.
- Taking a PHC approach is about meeting the majority of people’s health needs through services provided directly in the community where they live. A PHC approach means working with multidisciplinary teams – doctors, nurses, caregivers, therapists, and others – to treat the person rather than the disease.
- By providing health care services
throughout a person’s life, PHC allows people to develop long-term partnerships
with their care providers. And it means that health care providers can address
not only treatment needs, but also prevention, health promotion, rehabilitation
and palliation services.
- Primary health care encompasses a broad spectrum of areas and activities, including (but not limited to): rehabilitation, health workforce, mental health, digital health, sexual and reproductive health, and quality, among others. To assist countries and health professionals to understand how each of these areas is implicated in primary health care, WHO has produced the Technical Series on Primary Health Care.
- Assessing, measuring, improving PHC
- Turning a political commitment into reality on the ground begins with a thorough, evidence-based understanding of the existing system. In other words, before taking action, countries will need to carry out an assessment of the current state of PHC. There are a number of tools available to carry out such an evaluation.
- WHO has, with the support of partners, created the PHC Operational Framework. This document outlines a number of PHC levers which countries can use to guide the move to a PHC model and to assist countries in judging the results of their efforts and determining whether or not they are on track to meet their goals, a Monitoring and Evaluation Framework.
- Management of primary care center
- Analyzing health situation
Population (catchment area)
- Statistics
- Area Epidemiology
- Medical facilities
- Manpower
- Training facilities
- Attitude and believes of population
- Establishment of objectives and goals
- At all levels
- Long term
- Short term
- Putting in mind resources
- Assessment of resources
- Manpower
- Money
- Skills
- Knowledge
- Materials
- Fixing priorities
- Write up your plan
- Detailed covering all aspects
- Well defined cost and time
- Programming and implementation
- Fix responsibility for every person to achieve goals
- For implementation
- § Define task
- § Involve selection , training, motivation, manpower
- § Organization and communication
- Monitoring
- Its continuous process of observation, recording, and reporting on activities thus it involves keeping activities on the track and correction of any deviation
- Evaluation
- Assessment of achievement of the stated goals
- § Adequacy
- § Efficiency
- § Acceptance
- Assignment 3
- Ø SDGs
- Ø Primary Health Care Policy Framework in Kenya
- Ø PHC Operational Framework
- Ø Health Systems organization in Kenya
- Ø Discuss The Past, The Present and The Future of PHC
Click here to access Unit one Content..
Topic 1: Primary care is an approach that:
- Primary care is an approach that:
- Focuses on the person not the disease, considers all determinants of health
- Integrates care when there is more than one problem
- Uses resources to narrow differences
- Forms the basis for other levels of health systems
- Addresses most important problems in the community by providing preventive, curative, and rehabilitative services
- Organizes deployment of resources aiming at promoting and maintaining healt
- The doctor-patient relationship is central to what we do as family practitioners
- The practice of family health is community-based
- The family clinician is a resource to a defined population
- The family practitioner must be a skilled, effective clinician
Click here to access Unit one Content..
Topic 1: Home Based Care
HOME BASED CARE IS A MECHANISM OF CARE PROVISION WHICH INCLUDES THE FOLLOWING COMPONENTS
A. PHYSICAL
Care providers should always ensure that a patient receives adequate attention on the following: Treatment of opportunistic infections and other infections and appropriate nursing care at all times
Monitoring for early side effects and continuous adherence, pain relief with appropriate medications e.g. use of NSAIDs, Opiods etc.
B. NUTRITIONAL CARE
Nutritional care and support patient should be educated and appropriate nutrition using locally available food and guided on feeding patterns and preparation of the food to suit the condition of the patient e.g. feeding schedule depending on the medication
C. HYGIENE
The patient and family members should be educated on the practices of appropriate hygiene e.g. oral, skin, hair and environmental care
D. EXERCISES
Exercise is needed regularly and if they are too weak the family members should assist the patient in doing passive exercises for body movement and enhances blood circulation thus reducing the risk of complication such as bed sores and pulmonary embolism
E. EMOTIONAL SUPPORT
Patients suffering from any chronic or terminal illness usually have a lot of fear and worries .Care givers should therefore provides emotional support and help them to ventilate and deal with the conditions .Drug adherence issues when travels are planned ,business trips to be made or transfer planned.
F. SOCIAL SUPPORT
Patients suffering from terminal illness usually suffer from loneliness and neglect .Care givers should be involved in recreational activities as appropriate and support or self help groups in the community should be identified for the patient to interact with
G. SPIRITUAL SUPPORT
Addressing spiritual needs is an important aspect in any type of care. Chronically ill patients often lose hope and reasons to continue living which is often relieved through re-assurance and spiritual care. This must be determined and attended to appropriately thus the need to involve faith based organizations.
H. LEGAL SUPPORT
Patients should be informed about how and where to get aid that they need especially in areas such as inheritance, wills, writing and human rights issues e.g. Join PLHA support groups.
I. ECONOMIC SUPPORT
Financial burdens to the family increases given the additional medical expenses. If the bread winner is the affected party, there’s further constrains hence limited family resources. It’s therefore necessary for home based care givers to be aware of economic support networks and opportunities where such issues can be addressed.
ASSIGNMENT: READ AND MAKE NOTES ON PREVENTION IN HOME BASED CARE: FOCUS ON:
1. PATIENTS CLINICALLY ILL
2. PATIENT ON ANT CANCERS MEDICATION
3. CARE BY HOUSEHOLD MEMBERS AND COMMUNITY
Click here to access Unit one Content..
Topic 1: ESSENTIAL COMPONENTS OF HOME BASED CARE
|
CATEGORY |
SUB-CATEGORY |
|
|
1. |
PROVISION OF CARE |
-Basic physical care - Palliative Care - Prevention counseling -Nutrition counseling -Psychosocial support counseling - Care of affected and infected children |
|
2. |
CONTINUUM OF CARE |
-Accessibility, continuity of care,Refferal and supportive services,knowledge of community care, case finding , case management |
|
3. |
EDUCATION |
Curriculum development, outreach, Stigma reduction, Media involvement, Evaluation of education |
|
4. |
SUPPLIES AND EQUIMENT |
Location of hbc team/C supplies,management,monitoring ,HBC kits, record keeping |
|
5. |
STAFFING |
Supervision and co-coordinating home based care,Recruitment,Retaining Staff |
|
6 |
FINANCING AND SUSTAINABILITY |
Budget and finance management, Technical support, Community funding, Encouraging volunteers, Pooling resources, Free services |
|
7. |
MONITORING AND EVALUATION |
Quality assurance, Quality of care indicators, Monitoring and supervion,Informal and formal evaluation |
Click here to access Unit one Content..
Topic One: Summary
Define PHC
Outline the concepts and principles of primary Health care(PHC) in Kenya
Explain the organisation of primary health care in Kenya.
Assess the primary health needs in a community
Initiate and implement co-ordinated primary health care activities.
Describe the strategies of primary health care
Healthcare services in Kenya
Click here to access Unit one Content..
Topic One: Further Reading
Essentials of community health by Jaypee
Community health –IRC wash
Community health –Third edition –Chris wood
Community medicine manual- Rajvir BhalwarHealth promotion materials
UNIT FOUR
HEALTH PROMOTION APPROACHES METHODS AND MATERIALS
Approaches in health promotion
· Medical or preventive
· Behavioral change
· Education
· Empowerment
· Social change
Health promotion intervention
Definition;
These are health activities used by programme planners to bring about outcomes identified in the promotion program
These activities are sometimes referred to as treatments
Types of intervention activities
1. Communication activities- useful in
Ø Increasing awareness and knowledge
Ø Changing and reinforcing attitudes
Ø Providing cues for action
Ø Demonstrating simple skills
2. Education activities- through
Ø Seminars
Ø Workshops
Ø Lectures
Ø Discussions
Ø Computerized instructions
3. Behavior modification activities- techniques intended to help those in the target population experience a change in behavior
4. Environmental change activities- measures that alter or control the legal, social, economic and physical environment(changes in those things around individuals that may influence their awareness, knowledge, attitudes, skills or behavior) e.g.
Ø Posting of no smoking sign
Ø Eliminating ash trays
Ø Provision of showers
Ø Use of role models
Ø Food labeling etc
5. Regulatory activities- includes use of
Ø Executive orders
Ø Laws
Ø Ordinances
Ø Policies
Ø Regulations
Ø Formal and informal rules
6. Community advocacy activities- used to influence social change by the community becoming involved in the institution and decisions that will have an impact on their lives through;
Ø Personal visit to educate or lobby key people
Ø A community rally
Ø TV or radio appearance to express your views
Ø Newspaper editors
7. Organizational culture activities- cultures expresses what is and what is not considered important to the organization established through;
Ø Norms
Ø Traditions
8. Incentives and Disincentives- an incentive can increase the perceived value of activity , motivate people to get involved and remind programme participants their commitment towards goals for behavior change
Disincentives can be used to discourage a certain behavior I.e. fine for not wearing safety belt, tax on cigarettes etc.
9. Health status evaluation activities- checks the current health status in the target population through;
Ø Health risk appraisal form
Ø Self-screening
Ø Clinical screening
10. Social activities- social support could work as in incentive, this could be through;
Ø Support groups
Ø Buddy support
Ø Social activities
Ø Social netwoks
11. Technology delivered activities- with technology programmes are now delivered through a variety of ways;
Ø Internet
Ø Computer assisted instructions
Ø Outreach
Ø Telephone delivered interventions
Methods and approaches of health promotion
1. Individual approach- it is the cradle of health promotion, this can be through;
Ø Individual advice
Ø Counseling
Merit: allows better possibilities for success than any other medium
Limitation: it is labor intensive to reach everyone in a large population
2. Group approach- offers an intermediary between one to one approaches and wider community appeals through media and whole community approaches, methods used include;
Ø Seminars
Ø Lectures
Ø Skills training
Ø Simulations
Ø Games
3. General population- done through mass media
Mass media in health promotion
Definitions
Ø Mass media- any printed or audio-visual materials designed to reach a mass audience
Ø Message- a cultural communication encoded in signs and symbols
Ø Marketing- the sum total of all activities designed to persuade people to adopt certain behaviors
Ø Advertising- one component of marketing mix
Ø Audience segmentation- the division of a mixed population into more homogenous groups or market segments
Uses of mass media
· Raising consciousness about health issues
· Helps place health on the public agenda
· Conveying simple information
· Change behavior if other enabling factors are present
Factors important to media effectiveness
I. Credibility- the source must be trusted and reliable
II. Context- the message should be relevant to the receiver
III. Content- the message must be meaningful
IV. Clarity- message should be easily understood
V. Continuity- consistency in the message delivery
VI. Channels- should be popular with the masses
VII. Capability- the receiver must be capable of acting on the message meaningfully
VIII. Collaboration- media professionals should be involved to determine how best to use the media
Different types of mass media
1. Limited reach media
· Pamphlets
· Information sheet
· Newsletters
· Posters
· T-shirts
· Stickers
· Videos
2. Mass reach media
· Television
· Radio
· Newspapers
· Magazines
When to use mass media in health promotion
Ø When a wide exposure is desired
Ø When public discussion is likely to facilitate the educational process
Ø When awareness is the main goal
Ø When media is on-side
Ø When accompanying on the ground back-up can be provided
Topic 4: HEALTH PROMOTION MATERIALS
Objectives
By the end of this topic you should be able to;
- Plan ,organise and facilitate health education- related messages
- Design health promotion materials
Health promotion materials
UNIT FOUR
HEALTH PROMOTION APPROACHES METHODS AND MATERIALS
Approaches in health promotion
· Medical or preventive
· Behavioral change
· Education
· Empowerment
· Social change
Health promotion intervention
Definition;
These are health activities used by programme planners to bring about outcomes identified in the promotion program
These activities are sometimes referred to as treatments
Types of intervention activities
1. Communication activities- useful in
Ø Increasing awareness and knowledge
Ø Changing and reinforcing attitudes
Ø Providing cues for action
Ø Demonstrating simple skills
2. Education activities- through
Ø Seminars
Ø Workshops
Ø Lectures
Ø Discussions
Ø Computerized instructions
3. Behavior modification activities- techniques intended to help those in the target population experience a change in behavior
4. Environmental change activities- measures that alter or control the legal, social, economic and physical environment(changes in those things around individuals that may influence their awareness, knowledge, attitudes, skills or behavior) e.g.
Ø Posting of no smoking sign
Ø Eliminating ash trays
Ø Provision of showers
Ø Use of role models
Ø Food labeling etc
5. Regulatory activities- includes use of
Ø Executive orders
Ø Laws
Ø Ordinances
Ø Policies
Ø Regulations
Ø Formal and informal rules
6. Community advocacy activities- used to influence social change by the community becoming involved in the institution and decisions that will have an impact on their lives through;
Ø Personal visit to educate or lobby key people
Ø A community rally
Ø TV or radio appearance to express your views
Ø Newspaper editors
7. Organizational culture activities- cultures expresses what is and what is not considered important to the organization established through;
Ø Norms
Ø Traditions
8. Incentives and Disincentives- an incentive can increase the perceived value of activity , motivate people to get involved and remind programme participants their commitment towards goals for behavior change
Disincentives can be used to discourage a certain behavior I.e. fine for not wearing safety belt, tax on cigarettes etc.
9. Health status evaluation activities- checks the current health status in the target population through;
Ø Health risk appraisal form
Ø Self-screening
Ø Clinical screening
10. Social activities- social support could work as in incentive, this could be through;
Ø Support groups
Ø Buddy support
Ø Social activities
Ø Social netwoks
11. Technology delivered activities- with technology programmes are now delivered through a variety of ways;
Ø Internet
Ø Computer assisted instructions
Ø Outreach
Ø Telephone delivered interventions
Methods and approaches of health promotion
1. Individual approach- it is the cradle of health promotion, this can be through;
Ø Individual advice
Ø Counseling
Merit: allows better possibilities for success than any other medium
Limitation: it is labor intensive to reach everyone in a large population
2. Group approach- offers an intermediary between one to one approaches and wider community appeals through media and whole community approaches, methods used include;
Ø Seminars
Ø Lectures
Ø Skills training
Ø Simulations
Ø Games
3. General population- done through mass media
Mass media in health promotion
Definitions
Ø Mass media- any printed or audio-visual materials designed to reach a mass audience
Ø Message- a cultural communication encoded in signs and symbols
Ø Marketing- the sum total of all activities designed to persuade people to adopt certain behaviors
Ø Advertising- one component of marketing mix
Ø Audience segmentation- the division of a mixed population into more homogenous groups or market segments
Uses of mass media
· Raising consciousness about health issues
· Helps place health on the public agenda
· Conveying simple information
· Change behavior if other enabling factors are present
Factors important to media effectiveness
I. Credibility- the source must be trusted and reliable
II. Context- the message should be relevant to the receiver
III. Content- the message must be meaningful
IV. Clarity- message should be easily understood
V. Continuity- consistency in the message delivery
VI. Channels- should be popular with the masses
VII. Capability- the receiver must be capable of acting on the message meaningfully
VIII. Collaboration- media professionals should be involved to determine how best to use the media
Different types of mass media
1. Limited reach media
· Pamphlets
· Information sheet
· Newsletters
· Posters
· T-shirts
· Stickers
· Videos
2. Mass reach media
· Television
· Radio
· Newspapers
· Magazines
When to use mass media in health promotion
Ø When a wide exposure is desired
Ø When public discussion is likely to facilitate the educational process
Ø When awareness is the main goal
Ø When media is on-side
Ø When accompanying on the ground back-up can be provided
Topic 2: Further Reading
Reference Material
1. Barton E. et al (1980) On Being InCharge. Geneva: World Health Organization.
2. Basavanthappa, B. P. (2000). Nursing Administration. New Delhi, Jaypee Brothers Medical Publishers Ltd.
3. Bennet, R. (2004) Management. Essex: Pearson Education Ltd.
4. Cole, G. A. (1996) Management - Theory and Practice. London: Martins the Printers.
5. Tappen, R. M. (2001) Nursing Leadership and Management 4th F.A Davis, Philadelphia.
Further Reading Material
Topic 3: Managing Materials
Materials are essential resources to achieve the objectives of the health care institution. For quality and efficient services, the materials must be in the right place, at the right time when needed and in right quantity
Activities Which Pertain to Materials
Management
i. Demand estimation
Since a large quantity of materials are used in hospitals and in specific units/wards, you need to identify your requirements or needs.
ii. Procurement
Having come up with your list the next step is procurement or ordering. Some institutions have laid rules and regulations regarding procurement. This is aimed at reducing wastage and maximizing the value of money
iii. Receipt and Inspection
• The materials received should be subjected to either physical or chemical inspection. This ensures that you receive the right quality of material supplied to the organization.
iv. Storage
The materials should be in a store within or near the institution. The store should be of adequate size to accommodate the materials required for different types of usages eg. Fridges, shelves, cupboards
v. Inventory Control (Issue and use)
This means stocking adequate numbers so that materials are available whenever required. Close supervision of movement of materials or consumption rate is a good tool for proper control
Time management
Def. :- act or process of exercising conscious control over amount of time spent on specific activities in order to increase efficiency and effectiveness
Time management skills
✔Set goals – realistic and achievable
✔Prioritize work – make a list of task
✔Delegate task – to your subordinates as per their skills
✔Avoid distractors - i.e. email face book politics
✔Organize your time - identify when you waste time and reduce
✔Break down tasks – so as to accomplish one step at a time
✔Set deadlines – set realistic deadlines for task and stick to it challenge your self and meet the deadline ,reward your self for meeting difficult tasks
✔Avoid stress – stress occurs when we accept more than our abilities resulting into tiredness and loss of productivity ,delegate tasks and leave time for relaxation
1. Tasks which have to be done. These relate to key responsibilities eg. Clinical or administrative duties.
2. Tasks into which you are pressurized by other people.
Some of these are important and must be done while others you do because you do not want to say no.
3. Tasks which you do because you want to.
These are usually your own choices and include tasks which someone else could do well eg. attending a association meeting
Time Wasters
- Interruptions such as telephone calls and drop-in visitors.
- Lack of clear cut goals, objectives and priorities.
- Meetings both scheduled and unscheduled.
- Lack of daily and/or weekly plans.
- Lack of self discipline.
- Failure to delegate.
- Ineffective communication.
- Inability to say no.
Principles of Time Management
1. Goal Setting
The nurse manager sets both organizational and personal goals. The goals are either short or long term and provide direction and vision for actions as well as time frames in which activities will be accomplished.
2. Time Analysis
The manager should conduct a survey of how she/he spends a day. Reviewing the daily schedule and keeping it accurate may demonstrate how time is used.
3. Priority Setting
Time frames for achievement of goals are identified by the nurse manager. The "to do" list should be prioritized by classifying activities as e.g. "1" for urgent or "2" not urgent but important and "3" less important.
4. Delegation
A number of activities may be delegated by the nurse manager
5. Controlling Interruptions
Identify causes of interruptions and plan to reduce them. Some could become a planned and scheduled activity.
Topic 3: Human Resource Development
Training
Training is the planned process of modifying employee behavior, attitude, and skill through learning in order to increase the probability of goal achievement.
Development
This usually suggests a broader view of knowledge and skills acquisition than training. It is less job oriented than career oriented. It is concerned more with employee potential than with immediate skills. It sees the employees as adaptable resources
Training and development cycle
• The primary objective of training is to reduce the gap between what employees know and what they should know. Systematic training is initiated by the organization’s policy and sustained by its training organization
Training involves five steps
- Needs analysis/identifying training needs: The first priority is to establish what the training and development needs of the organization are. A training need is any shortfall terms of employee knowledge, understanding, skill, and attitudes against what is required by the job or the demands of organizational change. This will involve use of job descriptions, employee’s appraisal records and any other data that may indicate such needs.
- Plan training required; The next step is to plan the training required to the needs identified. This involves such matters as setting budgets and timetables, and deciding on the objectives, content and methods of training to be employed
- Implementation/carry out the training: This is training the targeted employee/ group. The implementation of plan is a joint affair between the training specialist and their line and functional colleagues.
- Evaluation and follow up: Management assesses the programme success. This is by evaluating the results so that subsequent changes can be made if necessary. Then the cycle starts again.
- NB: Read and draw the systematic training basic cycle
Methods of training
- On the job training
- Apprenticeship training ( combination of classroom ,institutions and on the job training
- Vestibule training: This is an internal off the job training method in which the environment of the actual work place is simulated. Used by organizations where specific skills are needed before actual job performance
- Job Rotation; In this training method the employee is moved from one job to another. It gives the employee a chance to use a variety of skills and abilities.
- In coaching/mentoring: A senior experienced manager takes charge of training and development of a new incumbent. The mentor/trainer helps the employee to adjust both to the organizational culture and work setting
- JOB ANALYSIS
- Job analysis is the procedure through which you determine the duties of positions to be staffed in an organization and the characteristics of the people to hire for them.
- Job analysis produces information used for writing Job descriptions (a list of what the Job entails) and Job specification ( what kind of people to hire for the Job). The following types of information is gathered during Job analysis
- Work activities: identifying the tasks involved in the Job e.g giving medications, monitoring vital sign etc.
- Human behavior: Included here is information regarding Job demands such as lifting weights or walking long distances
- Machines, tool equipment's and work aids:
- Performance standards: This is the Jobs performance standards in terms of quality or quantity level of each Job duty. (The standards will be used to appraise the employees
- Job context: This includes physical working conditions, work schedule number of people with whom the employee wound normally interact, information about incentives etc.
- Human requirements: This is the job related knowledge or skills (education, training, work experience) and the required personal attribute (attitudes, physical characteristics personality interest)
Job description
- This is a written statement of what the worker actually does, how he or she does it, and what the jobs working conditions are.
- A job description set out the purpose of the job, where it fits in the organization structure, the context within which the job holder functions and the principal accountabilities of job holder(s) or the main tasks they have to carry out.
Sections of job description
A job description mainly contains the following sections.
- Job identification; This contains the job title e.g. manager, etc. It also contains the date that the job description was written, who prepared it, who approval the job description and the location of the job e.g. hospital in charge
- Job summary: This describes the general nature of the job and includes only it major functions or activities e.g. plan, directs, co-ordinates hospital activities.
- Relationships: This shows the job holders relationship with others inside and outside the organization e.g. reports to, supervises who? Works with etc.
- Responsibilities and duties: This section presents the jobs main responsibilities and duties. e.g. conducting performance appraisal, giving medication to patients etc.
- Standards of performance and working conditions: This lists the standards the employee is expected to achieve under each of the job description duties and responsibilities.
- Job specifications: It shows what kind of a person to and for what qualities that person should be tested e.g. the skills, knowledge, experience, attitudes etc.