Copar

Ailyn Brillo Pineda

Community Health Nursing Practice Utilizing COPAR

 Dr. Alberto Romualdez, former DOH secretary

described the Philippine health status as “ on continuing shift towards positive change despite age-old problems..”  Some infectious degenerative diseases are on the

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

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 Per 1000 population Crude Death

24.63

5.66; 4.8 in 1998

Rate per 1000 population Infant Mortality Rate

29 per 1000 live births

Maternal Mortality Rate

138 per 1000 live births

Total Fertility Rate

3.5

Age

Female

Male

Number

Percent

Number

Percent

0-4

4,721,115

5.6

4,937,632

5.9

5-9

4,643,067

5.5

4,832,467

5.7

10-14

4,500,519

5.3

4,792,979

5.7

15-19

4,229,087

5

4,418,572

5.2

20-24

3,905,441

4.6

3,983,027

4.7

25-29

3,541,009

4.2

3,557,779

4.2

30-34

3,160,534

3.8

3,141,953

3.7

35-39

2,776,133

3.3

2,756,653

3.3

40-44

2,374,323

2.8

2,374,463

2.8

45-49

2,006,520

2.4

2,006,056

2.4

50-54

1,631,337

1.9

1,629,315

1.9

55-59

1,319,097

1.6

1,296,672

1.5

60-64

1,013,026

1.2

963,875

1.1

65-69

767,324

0.9

704,079

0.8

70-74

546,329

0.6

475,228

0.6

75-79

374,459

0.4

298,154

0.4

80+

330,630

0.4

232,487

0.3

Total

41,839,950

49.7

42,401,391

50.3

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

AREA Philippines NCR (Metro Manila) CAR (Cordillera) Region 1 (Ilocos) Region 2 (Cagayan Valley)

No. of Livebirths 1,766,440 303,631 33,017 101,310 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 Foreign Countries Residence not stated CARAGA

9,327 114 9,327 Source: Philippine Health Statistics, 2000

5 Year Average (2000-2004)

2005*

CAUSE No. 1. Acute Lower RTI and Pneumonia 2. Bronchitis/ Bronchiolitis 3. Acute Watery Diarrhea

Rate

No.

Rate

694,209

884.6

690,566

809.9

669,800

854.7

616,041

722.5

726,211

928.3

603,287

707.6

4. Influenza

459,624

587.0

406,237

476.5

5. Hypertension

314,175

400.5

382,662

448.8

6. TB Respiratory

109,369

139.7

114,360

134.1

7. Diseases of the Heart

43,945

56.2

43,898

51.5

8. Malaria

35,970

46.1

36,090

42.3

9. Chickenpox

79,236

41.1

30,063

35.3

10. Dengue Fever 

15,383

19.6

20,107

23.6

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

MALE

FEMALE

Rate**

Rate**

BOTH SEXES

CAUSE 1. Acute Lower RTI and Pneumonia 2. Bronchitis/ Bronchiolitis 3. Acute Watery Diarrhea

Number

Rate*

888.8

868.0

776,562

929.4

651.8

817.1

719,982

861.6

668.5

651.5

577,118

690.7

4. Influenza

400.7

444.6

379,910

454.7

5. Hypertension

338.2

442.1

342,284

409.6

6. TB Respiratory

137.7

93.9

103,214

123.5

7. Chickenpox

51.5

56.2

46,779

56.0

8. Diseases of the Heart

38.5

45.1

37,092

44.4

9. Malaria

24.0

20.0

19,894

23.8

10. Dengue Fever 

17.8

17.1

15,838

19.0

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

AREA

Philippines NCR (Metro Manila)

Total Deaths

366,931 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

AREA Philippines NCR (Metro Manila)

Fetal Deaths 10,360 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

-

Cause

Number

Rate

Percent

 TOTAL

 1,732

 1.0

 100.0

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

819

0.5

47.3

2. Hypertension complicating pregnancy, childbirth and puerperium

510

0.3

29.4

3. Postpartum hemorrhage

263

0.2

15.2 8.0

4. Pregnancy with abortive outcome

138

0.1

5. Hemorrhage in early pregnancy

2

0.0

0.1

Cause

Number

Rate

Percent

1. Bacterial sepsis of newborn

3,161

1.9

14.6

2. Respiratory distress of newborn

2,298

1.4

10.6

3. Pneumonia

2,013

1.2

9.3

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

1,610

1.0

7.4

5. Congenital Pneumonia

1,510

0.9

7.0

6. Congenital malformation of the heart

1,444

0.9

6.7

7. Neonatal aspiration syndrome

1,146

0.7

5.3

8. Other congenital malformation

1,012

0.6

4.7

971

0.6

4.5

900

0.5

4.2

9. Intrauterine hypoxia and birth  asphyxia 10.Diarrhea and gastro-enterities of  presumed infectious origin

Infant Mortality: Ten (10) Leading Causes Number & Rate/1000 Live births & Percentage Distribution Philippines, 2005

Cause

5 Year Average (2000-2004)

2005*

Number

Rate

No.

Rate

1. Diseases of the Heart

66,412

83.3

77,060

90.4

2. Diseases of the Vascular system

50,886

63.9

54,372

63.8

3. Malignant Neoplasm

38,578

48.4

41,697

48.9

4. Pneumonia

32,989

41.4

36,510

42.8

5. Accidents

33,455

42.0

33,327

39.1

6. Tuberculosis, all forms

27,211

34.2

26,588

31.2

7. Chronic lower respiratory diseases

18,015

22.6

20,951

24.6

8.Diabetes Mellitus

13,584

17.0

18,441

21.6

9. Certain conditions originating in the perinatal period

14,477

18.2

12,368

14.5

9.166

11.5

11,056

3.6

10. Nephritis, nephrotic syndrome and nephrosis

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  perinatal period

7,385

17.2

10. Nephritis, nephrotic syndrome and  nephrosis

6,548

15.3

Cause

No.

Rate

1. Diseases of the Heart 

33,251

78.5

2. Diseases of the Vascular system

23,841

56.3

3. Malignant Neoplasms

19,704

46.5

4. Pneumonia

18,365

43.3

5. Diabetes Mellitus

9,529

22.5

6. Tuberculosis, All Forms

8,359

19.7

7. Chronic lower respiratory diseases

6,501

15.3

8. Accidents

6,046

14.3

9. Certain conditions originating in the  perinatal period

4,983

11.8

10. Nephritis, nephrotic syndrome and  nephrosis

4,508

10.6

 Based on these statistics what are the challenges

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

Community Health Organizing Utilizing COPAR

Was developed and sponsored by the

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

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

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

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

 Community organizing as the main strategy to

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

Since Management Leadership and

Jurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts as leaders of the different levels of the students who were involved in COPAR Principles of management were applied in carrying out primary health care The community members, CHW’s and leaders were empowered to manage their own health projects Conducted seminars and trainings as well as

A social development

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

A collective, participatory,

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

A process by which a community

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

A continuous and sustained process of

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

1. COPAR is an important tool for

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

People, especially the most oppressed,

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

 A progressive cycle of action-reflection action

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

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)

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 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

 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

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

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

Activities in Building People’s Organization

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 

 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

CO choose one issue to work in

order to begin organizing the people

Going around and motivating the

people on an one on one basis to do something on the issue that has been chosen

People collectively ratifying what they have

already decided individually The meeting gives the people the collective power and confidence Problems and issues are discussed

Means to act out the meeting that

will take place between the leaders of the people and government representatives It is a way of training the people to participate what will happen and prepare themselves for such eventually

Actual experience of the

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

The people reviewing the steps 1-7 so to

determine whether they were successful or not in their objectives

Dealing with deeper, on going concerns to

look at the positive values CO is trying to build in the organization It gives the people time to reflect on the stark reality of life compared to the ideal

The people’s organization is the result of

many successive and similar actions of the people A final organizational structure is set up with elected officers and supporting members