Description, Phases and process

1. Ailyn Brillo Pineda

2. Community Health Nursing Practice Utilizing COPAR

3.  Dr. Alberto Romualdez, former DOH secretary described
the Philippine health status as “ on continuing shift
towards positive change despite age-old problems..”
 Some infectious degenerative diseases are on the rise
 Correlation of poor health with low socio-economic status is
well documented
 Filipinos are still living in the remote areas, where it is
difficult to deliver the health services they need
 Scarcity and exodus of MD’s, RN’s and RM’s add to the poor
delivery of the health care to the poor and deprived who
comprise the majority of the country’s 80 million or so total
population

4. INDICATORS MALE FEMALE BOTH SEXES
Population 41, 612, 133 41, 015,428 82, 663,561
Life Expectancy 72.78 years 67.53 years
Crude Birth Rate 24.63
Per 1000
population
Crude Death Rate 5.66; 4.8 in 1998
per 1000
population
Infant Mortality 29 per 1000 live
Rate births
Maternal 138 per 1000 live
Mortality Rate births
Total Fertility Rate 3.5

5. Female Male
Age
Number Percent Number Percent
0-4 4,721,115 5.6 4,937,632 5.9
5-9 4,643,067 5.5 4,832,467 5.7
10-14 4,500,519 5.3 4,792,979 5.7
15-19 4,229,087 5 4,418,572 5.2
20-24 3,905,441 4.6 3,983,027 4.7
25-29 3,541,009 4.2 3,557,779 4.2
30-34 3,160,534 3.8 3,141,953 3.7
35-39 2,776,133 3.3 2,756,653 3.3
40-44 2,374,323 2.8 2,374,463 2.8
45-49 2,006,520 2.4 2,006,056 2.4
50-54 1,631,337 1.9 1,629,315 1.9
55-59 1,319,097 1.6 1,296,672 1.5
60-64 1,013,026 1.2 963,875 1.1
65-69 767,324 0.9 704,079 0.8
70-74 546,329 0.6 475,228 0.6
75-79 374,459 0.4 298,154 0.4
80+ 330,630 0.4 232,487 0.3
Total 41,839,950 49.7 42,401,391 50.3
Source: 1995 Census-Based National, Regional and Provincial Population
Projections: National Statistics Office

6. AREA No. of Livebirths
Philippines 1,766,440
NCR (Metro Manila) 303,631
CAR (Cordillera) 33,017
Region 1 (Ilocos) 101,310
Region 2 (Cagayan Valley) 59,585
Region 3 (Central Luzon) 200,361
Region 4 (Southern Tagalog) 299,872
Region 5 (Bicol) 117,979
Region 6 (Western Visayas) 123,299
Region 7 (Central Visayas) 153,080
Region 8 (Eastern Visayas) 61,873
Region 9 (Western Mindanao) 55,931
Region 10 (Northern Mindanao) 59,659
Region 11 (Southern Mindanao) 103,555
Region 12 (Central Mindanao) 44,231
ARMM 39,616
CARAGA 9,327
Foreign Countries 114
Residence not stated -
CARAGA 9,327
Source: Philippine Health Statistics, 2000

7. 5 Year Average (2000-2004) 2005*
CAUSE
No. Rate No. Rate
1. Acute Lower RTI and
694,209 884.6 690,566 809.9
Pneumonia
2. Bronchitis/
669,800 854.7 616,041 722.5
Bronchiolitis
3. Acute Watery
726,211 928.3 603,287 707.6
Diarrhea
4. Influenza 459,624 587.0 406,237 476.5
5. Hypertension 314,175 400.5 382,662 448.8
6. TB Respiratory 109,369 139.7 114,360 134.1
7. Diseases of the Heart 43,945 56.2 43,898 51.5
8. Malaria 35,970 46.1 36,090 42.3
9. Chickenpox 79,236 41.1 30,063 35.3
10. Dengue Fever 15,383 19.6 20,107 23.6
** Pneumonia only from 2000-2002
* reference year
Last Update: June 29, 2009

8. MALE FEMALE BOTH SEXES
CAUSE
Rate** Rate** Number Rate*
1. Acute Lower RTI and
888.8 868.0 776,562 929.4
Pneumonia
2. Bronchitis/
651.8 817.1 719,982 861.6
Bronchiolitis
3. Acute Watery
668.5 651.5 577,118 690.7
Diarrhea
4. Influenza 400.7 444.6 379,910 454.7
5. Hypertension 338.2 442.1 342,284 409.6
6. TB Respiratory 137.7 93.9 103,214 123.5
7. Chickenpox 51.5 56.2 46,779 56.0
8. Diseases of the Heart 38.5 45.1 37,092 44.4
9. Malaria 24.0 20.0 19,894 23.8
10. Dengue Fever 17.8 17.1 15,838 19.0
Source: 2004 Philippine Health Statistics
** rate/100,000 of sex-specific population
Last Update: February 11, 2008

9. AREA Total Deaths
Philippines 366,931
NCR (Metro Manila) 63,413
CAR (Cordillera) 5,041
Region 1 (Ilocos) 26,469
Region 2 (Cagayan Valley) 13,250
Region 3 (Central Luzon) 40,534
Region 4 (Southern Tagalog) 54,804
Region 5 (Bicol) 24,867
Region 6 (Western Visayas) 35,589
Region 7 (Central Visayas) 29,403
Region 8 (Eastern Visayas) 16,250
Region 9 (Western Mindanao) 9,650
Region 10 (Northern Mindanao) 10,700
Region 11 (Southern Mindanao) 20,045
Region 12 (Central Mindanao) 7,543

10. AREA Fetal Deaths
Philippines 10,360
NCR (Metro Manila) 2,333
CAR (Cordillera) 163
Region 1 (Ilocos) 725
Region 2 (Cagayan Valley) 143
Region 3 (Central Luzon) 824
Region 4 (Southern Tagalog) 2,253
Region 5 (Bicol) 620
Region 6 (Western Visayas) 699
Region 7 (Central Visayas) 1,056
Region 8 (Eastern Visayas) 247
Region 9 (Western Mindanao) 242
Region 10 (Northern Mindanao) 279
Region 11 (Southern Mindanao) 397
Region 12 (Central Mindanao) 203
ARMM 161
CARAGA 15
Foreign Countries -
Residence not stated -

11. Cause Number Rate Percent
TOTAL 1,732 1.0 100.0
1. Complications
related to pregnancy
occurring in the course 819 0.5 47.3
of labor, delivery
and puerperium
2. Hypertension
complicating
pregnancy, 510 0.3 29.4
childbirth and
puerperium
3. Postpartum
263 0.2 15.2
hemorrhage
4. Pregnancy with
138 0.1 8.0
abortive outcome
5. Hemorrhage in
2 0.0 0.1
early pregnancy

12. Cause Number Rate Percent
1. Bacterial sepsis of newborn 3,161 1.9 14.6
2. Respiratory distress of newborn 2,298 1.4 10.6
3. Pneumonia 2,013 1.2 9.3
4. Disorders related to short gestation
and low birth weight, not elsewhere 1,610 1.0 7.4
classified
5. Congenital Pneumonia 1,510 0.9 7.0
6. Congenital malformation of the heart 1,444 0.9 6.7
7. Neonatal aspiration syndrome 1,146 0.7 5.3
8. Other congenital malformation 1,012 0.6 4.7
9. Intrauterine hypoxia and birth
971 0.6 4.5
asphyxia
10.Diarrhea and gastro-enterities of
900 0.5 4.2
presumed infectious origin
Infant Mortality: Ten (10) Leading Causes
Number & Rate/1000 Live births & Percentage Distribution
Philippines, 2005

13. 5 Year Average
2005*
Cause (2000-2004)
Number Rate No. Rate
1. Diseases of the Heart 66,412 83.3 77,060 90.4
2. Diseases of the Vascular
50,886 63.9 54,372 63.8
system
3. Malignant Neoplasm 38,578 48.4 41,697 48.9
4. Pneumonia 32,989 41.4 36,510 42.8
5. Accidents 33,455 42.0 33,327 39.1
6. Tuberculosis, all forms 27,211 34.2 26,588 31.2
7. Chronic lower respiratory
18,015 22.6 20,951 24.6
diseases
8.Diabetes Mellitus 13,584 17.0 18,441 21.6
9. Certain conditions
originating in the perinatal 14,477 18.2 12,368 14.5
period
10. Nephritis, nephrotic
9.166 11.5 11,056 3.6
syndrome and nephrosis

14. Cause No. Rate
1. Diseases of the Heart 43,809 102.1
2. Diseases of the Vascular system 30,531 71.2
3. Accidents 27,281 63.6
4. Malignant Neoplasms 21,993 51.3
5. Tuberculosis, all forms 18,229 42.5
6. Pneumonia 18,145 42.3
7. Chronic lower respiratory diseases 14,450 33.7
8. Diabetes Mellitus 8,912 20.8
9. Certain conditions originating in the
7,385 17.2
perinatal period
10. Nephritis, nephrotic syndrome and
6,548 15.3
nephrosis

15. Cause No. Rate
1. Diseases of the Heart 33,251 78.5
2. Diseases of the Vascular system 23,841 56.3
3. Malignant Neoplasms 19,704 46.5
4. Pneumonia 18,365 43.3
5. Diabetes Mellitus 9,529 22.5
6. Tuberculosis, All Forms 8,359 19.7
7. Chronic lower respiratory diseases 6,501 15.3
8. Accidents 6,046 14.3
9. Certain conditions originating in the
4,983 11.8
perinatal period
10. Nephritis, nephrotic syndrome and
4,508 10.6
nephrosis

16.  Based on these statistics what are the challenges that
nurses, doctors or midwives and other health agencies face
in relation to health profile and growth rate of the
Philippine population?
 What preventive measures can be done?
 What can be done to promote and restore health?
 What health education can be administered by the
community health workers, doctors, nurses, midwives,
etc.?
 How can we improve the health care deliver system?
 How can increase the number of health workers?
 What can be done for people in the far flung areas to
prevent the occurrence of diseases and health hazards?

17. Community Health Organizing Utilizing COPAR

18.  Was developed and sponsored by the Philippine
Center for Population and Development (PCPD)
 To make health services available and accessible to
depressed and underserved communities in the
Philippines
 PCPD is a non-stock, non-profit institution, which
serves as a resource center assisting institutions and
agencies through programs and projects geared
toward the social human development of rural and
urban communities
 Formerly known as The Population Center
Foundation

19.  HRDP I
 Trained the faculty, medical/nursing students to
provide health care services to the far flung barrios
because of lack of man power for health services at the
same time that similar activities fulfilled the curricular
requirements of the students for public health
 The PCPD provides seed money for the income
generating projects
 The CO uses his/her own strategy or method in
developing the community
 Short-term service

20.  HRDP II
 The 2nd cycle uses the same strategy but the program
could not be sustained by the schools or hospitals and
the income-generating projects eventually become the
hindrance to the goal of achieving the health program
because the people tend to be more interested in the
income generated by the projects
 Both HRDP I and HRDP II have brought about some
changes in the community life of the people
 Established basic health infrastructure; basic health
services were increased; there were trained workers and
organized health groups to take care of the needs of the
community

21.  HRDP III
 PCPD refined the program and resulted to what is now
called HRDP III, which has these unique features:
 Comprehensive training of the staff and faculty of the
participating agency in which the community work was
initiated
 Periodic training program and regular assistance to the
participating agency were provided to strengthen the health
outreach program to become community oriented
 PHC as the approach with which all nursing/medical
students, their CI’s and indigenous health workers are
trained for community health work and around which all
other project inputs will revolve

22.  Community organizing as the main strategy to be
employed in preparing the communities to develop
their community health care systems and the
establishment of community health organization to
manage the community health programs
 Organizing work in the communities were done in 3
phases
 PAR as fascinating strategy for maximum community
involvement through collective identification and
analysis of community health problems and collective
health action
 Available funds to finance community initiated projects

23.  Since Management Leadership and Jurisprudence are
courses taught in the classroom members of this
group of students were trained to manage and acts as
leaders of the different levels of the students who
were involved in COPAR
 Principles of management were applied in carrying
out primary health care
 The community members, CHW’s and leaders were
empowered to manage their own health projects
 Conducted seminars and trainings as well as health
education and services needed by
community(exposure and immersion 6-8 weeks)

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

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

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

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

29.  1. COPAR is an important tool for community
development and people empowerment as this
helps the community workers to generate
community participation in development
activities.
 2. COPAR prepares people/clients to eventually
take over the management of a development
programs in the future.
 3. COPAR maximizes community participation
and involvement; community resources are
mobilized for community services.

30.  People, especially the most oppressed, exploited and
deprived sectors are open to change, have the capacity
to change and are able to bring about change.
 COPAR should be based on the interest of the poorest
sectors of society
 COPAR should lead to a self-reliant community and
society.

31.  A progressive cycle of action-reflection action which
begins with small, local and concrete issues identified by
the people and the evaluation and the reflection of and on
the action taken by them.
 Consciousness- raising through experimental learning
central to the COPAR process because it places emphasis
on learning that emerges from concrete action and which
enriches succeeding action.
 COPAR is participatory and mass-based because it is
primarily directed towards and biased in favor of the poor,
the powerless and oppressed.
 COPAR is group-centered and not leader-oriented.
Leaders are identified, emerge and are tested through
action rather than appointed or selected by some external
force or entity.

32.  Pre- entry Phase
 is the initial phase of organizing process where the
community/organizer looks for communities to serve/help
 It is considered the simplest phase in terms of actual
outputs, activities and strategies and time spent for it
 Activities include
 Community consultations/dialogues
 Setting of issues/ considerations related to site selection
 Development of criteria for site selection
 Site selection
 Preliminary social investigation (PSI)
 Networking with LGU’s, NGO’s and other departments

33.  Entry Phase
 Social preparation phase
 Activities done here includes:
 Integration with the community
 Sensitization of the community; information campaigns
 Continuing social investigation
 Core group formation:
 Development of criteria for the selection of CG members
 Defining the roles/functions/tasks of the CG
 Coordination /dialogue/consultation with other community
organizations
 Self-awareness and Leadership training (SALT), action,
planning
 This phase signals the actual entry of the community
worker/organizer into the community

34.  Community Study/Diagnosis Phase (Research Phase)
 Selection of the research team
 Training on the data collection methods and techniques;
capability-building (includes development of data collection
tools)
 Planning for the actual gathering of the data
 Data gathering
 Training on data validation (includes tabulation and
preliminary analysis of data)
 Community validation
 Presentation of the community
study/diagnosis/recommendations
 Prioritization of community needs/problems for action

35.  Community meetings to draw up guidelines for the
organizations of the CHO
 Election of officers
 Development of management systems and procedures,
including delineation of the roles, functions and task of
officers and members of the CHO
 Team building/Action-Reflect Action (ARA)
 Working out legal requirements for the establishment of
the CHO
 Organization of the working committees and task
groups(e.g. education and training, membership of
committees)
 Training of the CHO officers/community leaders

36.  Community Action Phase
 Organization and training of the community health
workers (CHW’s)
 Development of criteria for the selection of CHW’s
 Selection of CHW’s
 Training of CHW’s
 Setting up of linkages/network referral systems
 Initial identification and implementation of resource
mobilization schemes

37.  Sustenance and strengthening phase
 Occurs when the community organization has already
been established and the community members are
already actively participating in community-wide
undertakings
 Strategies used may include:
 Education and training
 Networking and linkages
 Conduct of mobilization on health and development
concerns
 Implementation of livelihood projects
 Developing secondary leaders

38. Activities in Building People’s Organization

39.  A CO becoming a par with the people in order to:
 Immerse himself in the poor community
 Understand deeply the culture, leaders, history,
rhythms and lifestyle in the community
 Methods of Integration includes:
 Participation in direct production activities of the
people
 Conduct of house visits
 Participation in activities like birthdays, fiestas, wakes,
etc
 Conversing with people where they usually gather such
as stores, water, walls, washing streams, or churchyards
 Helping out in the household chores like cooking,
washing the dishes, etc

40.  A systematic process of collecting, collating, analyzing data to
draw a clear picture of the community
 Also known as the COMMUNITY STUDY
 Pointers for the conduct of SOCIAL INVESTIGATION
 Use of survey or questionnaires is discouraged
 Community leaders can be trained to initially assist the
community worker/organizer in SI
 Data can be more effectively and efficiently collected through
informal methods-house visits, participating in conversations in
jeepneys and others
 Secondary data should be thoroughly examined because much of
the information might already be available
 SI is facilitated if the CO/ community worker is properly
integrated and has acquired the trust of the people
 Confirmation and validation of community data should be done
regularly

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

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

43.  People collectively ratifying what they have already
decided individually
 The meeting gives the people the collective power
and confidence
 Problems and issues are discussed

44.  Means to act out the meeting that will take
place between the leaders of the people and
government representatives
 It is a way of training the people to
participate what will happen and prepare
themselves for such eventually

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

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

47.  Dealing with deeper, on going concerns to look at the
positive values CO is trying to build in the
organization
 It gives the people time to reflect on the stark reality
of life compared to the ideal

48.  The people’s organization is the result of many
successive and similar actions of the people
 A final organizational structure is set up with elected
officers and supporting members