CHN 2
MODULE 4: COMMUNITY ASSESSMENT
COMMUNITY ASSESSMENT
The data needed to be collected depend on the objectives of community assessment.
In general, the nurse needs to collect data on three categories of community health.
Determinants:
people
place
social system.
DATA COLLECTED WILL BE USED FOR THE HEALTH P.A.T.C.H
(Planned Approach To Community Health)
PROCESS FOR HEALTH PLANNING
Community Profile: demographic educational and economic data
Morbidity and Mortality data, including unique health events(e.g., completion of barangay health station, a typhoon that caused flooding of residential areas)
Behavioral Data focusing on behavioral risk factors, such as smoking, drinking and leading a sedentary lifestyle, and prevailing good health practices in the community, such as breastfeeding and getting regular exercise.
Opinion data from community leaders, such as what they think about the main health problems of the community, their causes, measures that may alleviate or correct them.
*Problem-Oriented Assessment is focused on a particular aspect of health: focusing on what’s problem the community have in mind
TOOLS IN COMMUNITY ASSESSMENT
PRIMARY DATA SOURCE
Observation
ocular survey/ windshield survey
Survey
Informant interview
talks to the community people
key informants: consist of formal and informal community leaders or persons of position and influence
Community forum
pulong – pulong sa barangay
Focus group
SECONDARY DATA SOURCE
health records and reports
Field Health Service Information System
(FHSIS) recording and reporting tools
FHSIS is as basis for
priority setting by local governments
planning and decision making at different levels(barangay, municipality, district, provincial, and national)
monitoring and evaluating health program implementation
FAMILY AS THE UNIT OF SERVICE
FAMILY: a group of persons usually together and composed of the head and other persons related to the need by blood, marriage or adoption.
Moreover, they are sharing the same resources (such as food, utilities, money and alike), social responsibilities and privilege.
Two families sharing one household but 1 decision maker considered as 1 family if both have a decision-maker they are considered as 2 families.
Household - A social unit consisting of a person living alone or a group of persons who sleep in the same house. A household may consist of several families.
DEMOGRAPHIC DATA
Age-age as of last birthday
Sex- male or female
Civil status-enter any of the following:
Single (S)-person is not and has never been married
Married (M)-person living with another person bound by legal rites.
Common law (CL)-person living with another person without the benefit of a legal marriage
Widowed (W)-person whose spouse has died, and has not remarried. Widow or female, widower for male.
Separated/Annulled- a person whose bond of marriage has been dissolved and can therefore remarry.
Religion- Indicate religion for each family member.
Note: in case of children (0-14), they assume the mother’s religion as articulated in the family code of the Philippines. Indicate religious sect.
Head of the Family- The primary decision-maker in the family; or he/she could be the recognized head by the family.
FAMILY TYPE BASED ON WHO MAKE DECISIONS (AUTHORITY)
PATRIARCHAL - full authority on the father or any male member of the family e.g. eldest son, grandfather
MATRIARCHAL - full authority of the mother or any female member of the family, e.g. eldest sister, grandmother
EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother decides
DEMOCRATIC - everybody is involved in decision making
AUTHOCRATIC-
LAISSEZ-FAIRE- "full autonomy"
MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is working overseas)
PATRICENTIC- the father decides/ takes charge in absence of the mother
FAMILY TYPE BASED ON RESIDENCE
PATRILOCAL – family resides / stays with / near domicile of the parents of the husband
MATRILOCAL – live near the domicile of the parents of the wife
TYPES OF FAMILY IN THE COMMUNITY
Nuclear Family – consists of father, mother and children (either adopted or biological)
Extended – consists of father, mother, and children with other relatives
Single-Parent – single with children
Binuclear/Blended/Reconsituted – extended family consisting of 2 or more separate household from separated or divorced parents with children
Step Family –remarriage of a widowed person with children
Compound – one man/woman with several spouses
Cohabiting family – lived-in unmarried couple
Dyad – husband and wife without children
Homosexual family – female-female or male/male, gay/lesbian with or without children
Communal family – e.g. bahay-ampunan, Home for the aged, Kumbento
No- Kin - have no legal or blood tie to each other
DEMOGRAPHIC DATA
Educational Status
Indicate status for each member of the family. Indicate whether he/she is:
degree holder/college graduate
presently studying and highest completed level
had stopped studying and highest completed level
no formal education
For collation purposes, further break it down into:
Degree holders/ college graduate - also include graduates of vocational courses
Currently studying- elementary, high school, and college level
Had stopped studying- elementary graduate/undergraduate
High school graduate/undergraduate
College/vocational courses undergraduate
Literacy Rate - in the Philippines, a person aged 15 years old and above who are unable to read and write is considered illiterate.
# people 15 y/o and above who can read and write x 100 # of people of aged 15 and above
Ethnic Background
Refers to selected cultural and sometimes physical characteristics used to easily divide people into groups or categories, considered to be significantly different from others.
These people may be considered as indigents or having special needs.
Primary dialect spoken – primary dialect used by the family
Patterns of migration – determine whether there is a large number of in-migration or out-migration in the community as well as the reasons behind the trends.
Determine if
Transient: below 6 months;
Permanent: 6 mounts above.
Disadvantage people – these are people or groups of people who have special needs in terms of basic needs and services, and not necessarily financial in nature
Individuals or group of individuals who are considered economically, physically and socially disadvantaged.
E.g. indigent children, out-of-school youths, physically and mentally disabled persons, distressed individuals and families, and disadvantaged children, refugees, tribes.
Population Density – determines congestion of the place
Land area (sq. km) x 100
Total population
Compute population density per purok if barangay has puroks
Population Projection
Important in establishing what services and health programs to implement and strengthen.
For example, in the event that current trends in birth and death rates would lead to a dramatic increase in the population, the community can strengthen their program on maternal and child care, and immunization programs to cater to the young population, at the same time launching programs on family .planning to control the growth of population.
Urban-Rural Index (if applicable)
Determine as to what percent of the community can be considered urbanor rural.
Urban Barangay – Includes the criteria on the economic and social functions of barrios, poblaciones, and central districts as follows:
In their entirety, all municipal jurisdictions which, whether designated as chartered cities, provincial, capital or not, have a population density of at least 1,000 persons per square kilometer.
Poblaciones or central districts of municipalities and cities which have a population density of at least 500 persons per square kilometer.
Poblaciones or central districts (not included in nos. 1 and 2) regardless of population size which have the following:
Street pattern, i.e., network of street in either at parallel or right angle orientation;
At least six establishments (commercial, manufacturing, recreational and/or personal service); and
At least three of the following:
A town hall, church or chapel with religious services at least once a month;
A public plaza, park or cemetery;
A market place or building where trading activities are carried on at least once a week; and
A public building like school, hospital, puericulture and health center or library.
Barrios/barangay having at least 1,000 inhabitants which met the conditions set forth in no. 3 above, and in which the occupation of the inhabitants is predominantly non-farming/fishing.
If a barangay has a population size of 5,000 or more, then a barangay is considered urban, or
If a barangay has at least one establishment with a minimum of 100 employees
If a barangay has 5 or more establishments with a minimum or 10 employees, and 5 or more facilities within the 2 km radius from the barangay hall
Rural Barangay – an area outside any area classified as urban
Occupational Status
states the present status of occupation at the time when the survey is conducted
Employed- a person in the service of another under any contract of hire
Unemployed- refers to a person who doesn’t have a means for income.
Self-employed - refers to a person who works for himself instead of as an employee of another person or organization, drawing income from trade or business.
Underemployed - to workers with high skill levels employed in low-wage jobs that do not require such abilities.
Retired - refers to a professional person, who stopped working due to age reasons.
COMMUNITY AS A SOCIAL SYSTEM
A. Economic Aspect
Combined Family Monthly income
The total combined monthly income of the family.
This includes all the incomes which are used by the family for its expenses.
An income exclusively of use by only one member of the family for personal purpose and allocation is not included in this category.
Monthly family expenditure - the totality of the monthly expenses of the family. It show’s here where the income of the family is allocated.
Livelihood- examples are sari-sari store, hog raising etc.
Priority expenditure - refers to the aspects that the family is giving more attention to than any other. The priority setting of the family to their needs.
B. Political/Leadership Aspect
Barangay officials - refer to the set of persons in authority to implement policies and organize the community in all aspects. This includes the barangay captain or chairman, and his subordinates.
Religious leaders - refer to the persons commonly seen and observed in religious rites and practices.
Elders - refer to the community’s senior constituents who have lived in the community for almost the rest of their lives.
recognized informal leaders
C. Environmental Aspect
Ownership Of The House
Owned - this refers to a property of a family, either a land property or a house property in which they have a power over it.
Rented - the family is taking or holding a land under an agreement to pay a certain amount for the rent. This rent refers to the money or the amount of money paid or due at intervals for the use of another’s property.
Lease to own - lease refers to a contract renting a land, buildings, etc., to another, for a specified period or for a period determinable at the will of either lessor or lessee in consideration of rent or other compensation. The lessee will have a property as soon as he has already paid the amount of the property.
Rent free - the family is not paying anything to the property that they are using.
Types Of Materials Used For House
Light - refers to such materials as bamboo, nipa, sawali, coconut leaves or cardboard.
Strong - refers to a predominantly concrete house.
Mixed - refers to a combination of light materials, wood and/or concrete. Typically concrete floor or foundation and light walls, or a concrete 1st floor and light 2nd floor.
Lighting Facilities
Artificial means of providing light/ illumination. Facilities used already reflect adequacy and safety for the family. (Ex. Electricity, kerosene, candles, or none.)
Types Of Excreta Disposal
Level I
Non-water carriage toilet facility – no water necessary to wash the waste into receiving space e.g. pit latrines, bored-hole latrine
Toilet facilities requiring small amount of water to wash the waste into the receiving space e.g. pour flush toilet & aqua privies
Pail System - a pail or box is used to receive the excreta and disposed later when filled. (Included ballot system where in excreta is wrapped in a piece of paper/plastic and thrown later.)
Open Pit Privy/Latrine - consist of a pit covered by a platform with a hole that is usually not covered. The platform may, in its simplest form, consist only of 2 pieces of wood or bamboo.
Closed Pit Privy/ Latrine- a pit privy in which the hole over the platform or toilet floor is provided with a cover
Types Of Pit Include
Ventilated Improved Pit or VIP, pit with a vent pipe
Reed Odorless Earth Closet or ROEC, a pit completely displaced from the superstructure and connected to the squatting plate by a curved chute.
Antipolo Type- toilet house is elevated and the shallow pit is extended upwards to the platform (toilet floor) by means of a chute or pipe made of metal, clay aluminum or board.
Bored-Hole Latrine- consists of a deep (usually more than 10 feet) but relatively narrow (less than 2 meters in diameter) hole made with boring equipment.
Overhung Latrine- toilet house is constructed over a body of water (stream, fake, and river) into which excreta is allowed to fall freely.
Level II
On site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal.
Flush Type- a toilet system where waste is disposed by flushing water through pipes (sewers) into a public sewerage system or into an individual disposal system like an individual septic tank.
Water Sealed Latrine- an Antipolo type of toilet, bored- hole latrine or any pit privy wherein a water sealed toilet bowl is placed instead of the simple platform hole(+)septic tank.
Level III
Water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant
Type Of Water Facilities
Level 1 (Point Source)
a protected well or a developed spring with an outlet but without a distribution system
Indicated for rural areas where houses are scattered
Serves 15-25 households; its outreach is not more than 250m from the farthest user
Yields 40-140 L/ min
Level II (Communal Faucet or Stand Posts)
With a source, reservoir, piped distribution network and communal faucets
Located at not more than 25 m from the farthest house
Delivers 40-80 L of water per capital per day to an average of 100 households
Serves 4 to 6 households per faucet
Fit for rural areas where houses are densely clustered
Level III (Individual House Connections or Waterworks System)
With a source, reservoir, piped distributor network and household taps
One or more faucets per household
Fit for densely populated urban communities
E.g. Nawasa, Maynilad
Sewerage System
Blind drainage - waste water flows through a system of closed pipes to an underground pit or covered canal.
Open drainage - waste water flows through a system of pipes (could be improvised from bamboo) to an open pit canal.
None - when no drainage system or container is used for garbage. Waste water from the kitchen flows directly to the ground, oftentimes forming a nearly permanent pool. Garbage is not put in a container when disposed of.
Types of Waste Disposal
Hog feeding - garbage is used as hog feed and also to chicken and other livestock
Open Dumping- refuse and/or garbage piled in a dumping place (with or without pit) with no soil covering
Open Burning- regularly piles refused/garbage and later burned in open air. This is uncontrolled burning which is usually done for yard and street sweeping. It may be allowed in rural areas where it will not worsen already existing air pollution.
Burial Pit - refuse/garbage placed in a pit and covered when filled up. There is no intention to dig it up later for use as fertilizer. This should be located 25 meters away from any well used for water supply.
Composting- involved buying or stacking of alternating layers of organic based refuse/garbage and ’treated soil’ arranged as to haste rapid decay and decomposition into compost. This organic mixture can later be used as fertilizer.
Garbage Collection - refuse/garbage collected by garbage truck or any type of garbage collection in the community.
Types of Waste Management
Recycling - ‘converting’ waste material for reuse in the future.
Reusing - to use something again, often for a different purpose and usually as an alternative to throwing it out
Source of Drinking Water
Commercially prepared water - includes all bottled water that have been treated with state of a art purification techniques bought usually at supermarkets, groceries, and convenient stores (mineral water)
Local water system - commonly known as faucet or gripo which is connected from a water distribution system, Level II (communal faucet) or level III (waterworks system) of water supply facilities.
Artesian well- commonly known as the poso, level I (point source) of water supply facilities.
Deep Well - an artificial excavation or structure put down by any method such as digging, driving, boring, or drilling for the purposes of withdrawing water from underground.
Surface Water - derived from streams, rivers, subjects to seasonal availability and are subjects to contamination if untreated
Ground Water - walls and springs.
Spring - groundwater seepages which are created when the level of underground water comes in contact with the surface. Contamination occurs at the point of seepage.
Rainwater-basically free from impurities. However contamination may occur at the collection and storage points, and by air pollution (ex., Acid rain)
Method of sanitizing water
Boiling - safest and purest way
Should be boiled for at least 3 minutes after reaching boiling point of 100 C to kill all vegetative bacteria, viruses, and fungi.
minimum of 3 minutes to maximum of 10 minutes for drinking
Sterilization: 30 minutes after the water starts to boil
Filtration
done before boiling or disinfecting common household filters used in the Philippines to separate solid particle from liquid if water comes from river;
cloth filters, intermittent water filter.
Sedimentation
impurities in water are allowed to settle at the bottom of the container for 30 minutes-1 hr and pouring the top part in a new clean container without creating turbulence.
Coagulation/Flocculation
uses aluminum crystal (tawas) that collects or absorbs particles from liquid part & becomes slimy
In 1 gallon of water, drop tawas (the size of
maggi cubes) & allow to stand for 6-8 hours
Initially, water appears to be cloudy then after 6-8 hours of standing, the water becomes clear
Chlorination
Uses 100% pure concentrated chlorine bought from botika or given free by health centers
To prepare stock solution (SS): in 1 liter drinking water, add 1 tablespoon of concentrated chlorine which is potent for 3-4 months
To prepare the chlorinated water: in 2 ½ gallons of drinking water (10,000 ml=10 liters), add 1 tablespoon from the prepared stock solution & let it stand for 30 minutes to react with water
Aeration
exposing drinking water in air to strengthen taste within 24 hours which is usually used in uphill areas where there’s less or no pollution
Buying commercially prepared water
Food Preparation
refers to the usual method of preparation of food
fried
steamed
grilled
boiled
sauteed
Authority consulted during illness
Authority- those who had a formal or informal training regarding health and health managements that are recognized by the people (i.e. doctors, albularyo, hilot, etc)
This is to establish if the disease or illness had been properly diagnosed. Before assessing this, ask first about the illness or disease suffered in the family for the year up to the present and if the family has done anything about it.
Perception on what is a healthy person
self explanatory. If they think a child that is malusog, walang sakit, mataba, masigla is considered healthy.
Somewhat affects the concept of health promotion and disease prevention within the community.
Perception on what causes illness
yields their knowledge, perception or any misconception about what causes disease or illness. ( maligno, duwende, engkanto etc)
COMMUNITY HEALTH PROGRAMS AND SERVICES
Presence, Awareness and utilization of community health programs
Description of existing health and health related programs that the community has or are implementing.
Awareness and utilization of community people regarding these programs
FGD should be done to inquire why they are not availing certain programs or following certain policies even if they are aware of it.
Method of family planning used
Natural or Artificial (read on types of natural and artificial FP methods).
Before asking this, inquire first if they are utilizing FP methods since this question does not necessarily apply to all. (for families whose mother’s age is within the range of 15-45 years.)
Nutritional Status of target age group (0-6 years old)
weigh children from 0-6 years old and identify presence of malnutrition with their respective categories
refer to DOH book; table for assessing malnutrition in children will be handed out.
Immunization status
Immunization status to target the age group of 0-12 months and 1 year to 5 years old.
Please specify the vaccine and the number of doses (if applicable).
MANPOWER RESOURCES
Categories of health manpower available - health manpower
refers to number of nurses; doctors, midwife, dentist, medical technician, BNS (Barangay Nutrition Scholar)/ BHWs and trained hilots (mga nagpapaanak) who are serving the community and their corresponding time of availability
Geographical distribution of health manpower
how health manpower is distributed within the community
Manpower-population ratio
nurse-population ratio, doctor-population ratio
Rural health Physician = 1:20,000
Public health Nurse = 1:20,000
Rural health Midwife = 1:5,000
Rural health Inspector = 1:20,000
Rural health Dentist = 1:50,000
MATERIAL RESOURCES OF THE COMMUNITY
Health budget and expenditures
percentage allotted, budgeting
Sources of health funding
Government, NGOs, private agencies
Categories of health institutions
Health centers, RHU, hospital, daycare center, clinics, lying-in
Categories of health services available
health programs
Hospital bed-population ratio
Distribution of health manpower according to health facilities
how health manpower is distributed to various community health facilities (barangay health center, hospital, Rural Health Units etc.)
Distribution of health manpower according to type of organizations
government, non-government, health units, private
MODULE 5: FIELD HEALTH SERVICE INFORMATION SYSTEM (FHSIS)
FIELD HEALTH SERVICE INFORMATION SYSTEM
FHSIS was designed to provide data to monitor activities in each health program as per E.O. 352
used by all levels of the government
It is a network of information
It is intended to address the short term needs of DOH and LGU staff with managerial or supervisory functions in facilities and program areas.
It monitors health service delivery nationwide.
OBJECTIVE OF FHSIS
To provide summary data on health service delivery and selected program accomplishment indicators at the barangay, municipality/ city, and district, provincial, regional and national levels.
To provide data which when combined with data from other sources, can be used for program monitoring and evaluation purposes.
To provide a standardized, facility-level data base that can be accessed for more in-depth studies.
To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promote activities.
IMPORTANCE OF FHSIS
Helps local government determine public health priorities.
Basis for monitoring and evaluating health program implementation.
Basis for planning, budgeting, logistics and decision making at all levels.
Source of data to detect unusual occurrence of a disease.
Needed to monitor health status of the community.
Helps midwives in following up clients.
Documentation of RHM/PHN day to day activities.
COMPONENTS OF FHSIS
Individual Treatment Record (ITR)
Target Client List (TCL)
Summary Table
The Monthly Consolidation Table (MCT)
DOH INNOVATION
Development and nationwide implementation of LGU-Based Electronic FHSIS (e-FHSIS) effective January of 2011.
FHSIS focuses on the programs of the DOH public health services (PHS), namely:
Maternal and Child (MCH);
Expanded Program on Immunization (EPI);
Control of Diarrheal Diseases (CDD);
Nutrition;
Family Planning ;
Maternal Care;
The Tuberculosis, Malaria, Schistosomiasis, and Leprosy Control progress;
Dental Health and
Environmental Health.
INDIVIDUAL TREATMENT RECORD (ITR)
The fundamental building block or foundation of the Field Health Service Information System is the INDIVIDUAL TREATMENT RECORD.
This is a document, form or piece of paper upon which is recorded the date, name, address of patient, presenting symptoms or complaint of the patient on consultation and the diagnosis (if available), treatment and date of treatment.
TARGET CLIENT LIST (TCL)
The Target Client Lists constitute the second “building block” of the FHSIS and are intended to serve several purposes
First is to plan and carry out patient care and service delivery. Such lists will be of considerable value to midwives/nurses in monitoring service delivery to clients in general and in particular to groups of patients identified as “targets” or “eligibles” for one or another program of the Department
TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS
Target Client List for Prenatal Care
Target Client List for Post-Partum Care
Target Client List of Under 1 Year Old Children
Target Client List for Family Planning
Target Client List for Sick Children
NTP TB Register
National Leprosy Control Program Form 2-Central Registration Form
SUMMARY TABLE
The Summary Tables is a form with 12-month columns retained at the facility (BHS) where the midwife records monthly all relevant data. The Summary Table is composed of:
Health Program Accomplishment this can serve as proof of accomplishments to show LGU officials whenever they visit the facility.
Morbidity Diseases the source of ten leading causes of morbidity for the municipality/city. This summary table will help the nurse and MHO to get the monthly trend of diseases.
THE MONTHLY CONSOLIDATION TABLE (MCT)
The Consolidation Table is an essential form in the FHSIS where the nurse at the RHU records the reported data per indicator by each BHS or midwife.
This is the source document of the nurse for the Quarterly Form.
The Consolidation Table shall serve as the Output Table of the RHU as it already contains listing of BHS per indicator.
FHSIS REPORTING
These are summary data that are transmitted or submitted on a monthly, quarterly and on annual basis to higher level. The source of data for this component is dependent on the records.
THE MONTHLY FORM
Program Report (M1)
The Monthly Form contains selected indicators categorized as maternal care, child care, family planning and disease control.
Morbidity Report (M2)
The Monthly Morbidity Disease Report contains a list of all diseases by age and sex. The Midwife uses the form for the monthly consolidation report of Morbidity Diseases and is submitted to the PHN for quarterly consolidation.
THE QUARTERLY FORM
Program Report (Q1)
The Quarterly Form is the municipality/city health report and contains the three-month total of indicators categorized as maternal care, family planning, child care, dental health and disease control
Morbidity Report (Q2)
The PHN uses the form for the Quarterly Consolidation Report of Morbidity Diseases to consolidate the Monthly Morbidity Diseases taken from the Summary Table.
THE ANNUAL FORMS (A-BHS, A1, A2 & A3)
A-BHS Form is the report of midwife which contains data on demographic, environmental and natality.
The report of nurse at the RHU/MHC are the Annual Form 1 which is the report on vital statistics: demographic, environmental, natality and mortality.
Annual Form 2 is the report that lists all diseases and their occurrence in the municipality/city. The report is broken down by age and sex.
Annual Form 3 is the report of all deaths occurred in the municipality/city. The report is also broken down by age and sex.
