THE COMMUNITY

BY

NDUBUISI, I.C.

THE ROLE OF HEALTH EDUCATION,

ENVIRONMENTAL SANITATION AND

MAINTENANCE OF ENVIRONMENTAL HEALTH.

HEALTH SUVEILLANCE, MOTIVATION AND

COMMUNITY PARTICIPATION IN CONTROL OF

COMMUNICABLE DISEASES.

It is an integral part of PHC

Health education is any combination of learningexperiences designed to help individuals andcommunities improve their health, by increasingtheir knowledge or influencing their attitudes.

It can also be defined as a carefully plannedmethod to influence and or change the attitude orbehaviour of individual or communities byincreasing their knowledge and understanding ofhealth and diseases.

It is the totality of educational efforts aimed at

helping, motivating and encouraging people to:

Want to be healthy

Know how to stay healthy

Do what they can to maintain health

Seek help as when needed

It involves the use of multiple strategies and methods

It is a systematically planned activity or process

It is a health intervention which is devoid of coercion

It is done with the full understanding and free acceptance by

the target audience

It focuses on the human health related behaviour or action:

o Healthy

o unhealthy

The objectives of health education include:

o Improvement in health e.g. diarrhoea incidence

o Change in behaviour, for instance hand-washing

o Change knowledge, beliefs and attitudes

o Enlist community support for health programmes

o Inform the community about medical advancesand their limitation

There three types of health education

Individual health education

Group health education

Mass media health education

It is usually the best and most

effective- this is because it allows

for close interaction

It only involves the client and the

health educator

The close relationship often

gives the client confidence in the

health educator and it may

increase compliance

This the most approach type forcommunity health education

It involves health educating a group ofpeople with related health issue(s).

The group should not be more than 5to 8 to an health educator.

Members of the group must bemotivated to participate in thediscussion.

Teaching aids like audio-visuals couldbe used.

This form of health education is done for a largegroup of people

It involve the use of radio, television, internet,bill boards etc.

Some of the disadvantages of this methodinclude:

o It consume a lot of money and time

o There may be no personal interraction

Lecture

Group discussion

Demonstration

Role play

Film show/drama

Workshop and seminars

Health talk

Performing health education involves the following steps

STEP I: Assessing the situation

STEP II: Diagnosing the problem

STEP III: Programme planning or planning the

programme

STEP IV: Implementation

STEP V: Evaluation (assess programme success)

Establishing relationship between individuals, groups and

institutions

Increasing awareness and upgrading knowledge

Persuading people to change

Influencing attitude

Facilitating the adoption of innovations and creating

sustained demand for health innovations

Encouraging individuals, groups and

communities to take responsibilities for their health

Motivating people to make informed decision

Empowering people with skills

Advocating for the recognition of the health

promotion preventing activities or practices as a

major investment

The World Health Organisation (WHO) defines

‘Environmental Sanitation’ as “the control of all those factors

in man’s physical environment which exercise or may

exercise a deleterious effect on his physical development,

health and survival.”

This involves keeping the environment free from things that

can cause accident or endanger the life of the populace

For example: uncompleted or dilapidated latrines, open

trenches, uncontrolled tipping methods of refuse disposal

There is also need for good drainage system

This is designed to emphasize adequate supplyof safe water and basic sanitation

To achieve this, the health worker needs toensure community participation and theinvolvement of the Government effort atproviding water and ensuring clean environment

The technology adopted for providing water inthe community should be appropriate (it must becheap, simple, easy to maintain and reliable)

Health surveillance is a system of ongoing health checks.

These health checks may be required by law for community

members who are exposed to noise or vibration, ionising

radiation, solvents, fumes, dusts, biological agents and

other substances hazardous to health.

Public health surveillance is the On-going, systematic

collection, analysis, and interpretation of health-related data

and dissemination for use in the planning, implementation,

and evaluation of public health practice on a specific

disease or other health-related event.

Such surveillance can:

serve as an early warning system for impending public

health emergencies

document the impact of an intervention, or track progress

towards specified goals

monitor and clarify the epidemiology of health problems, to

allow priorities to be set and to inform public health policy

and strategies

Public Health Surveillance has many uses:

Monitoring trends in health events.

Guiding decision making and action to reduce morbidity andmortality

Detecting cases for intervention, evaluate control andprevention measures.

Guiding planning, implementation and evaluation of publichealth programs, providing a basis for epidemiologicalresearch.

Estimate magnitude of the problem.

Portray the natural history of a disease.

Determine distribution and spread of illness.

Detecting potential outbreaks and threats to public health.

Monitor changes in infectious agents.

Directing public health interventions

Generate hypotheses, stimulate research.

There is an identifiable disease or other identifiable

adverse health outcome

The disease or health effect may be related to

exposure

There is a likelihood that the disease or health

effect may occur

There are valid techniques for detecting indications

of the disease or health effects

Health Surveillance Techniques should be:

Sensitive

Specific

Easy to perform and interpret

Safe

Non-invasive

Acceptable

A Community is a set of people living

together with common interest

There are different things that bind

people together. Such as: Territory ,

Sharing resources, Administrative

unit, Language, Religion, Culture,

Occupation

Community Mobilization refers to the process of building

social relationships in pursuit of common community

interests.

It is a capacity building process through which

community members, groups, and organizations plan,

implement, and evaluate sustainable programs and

activities in a participatory manner to achieve an agreed

upon goal.

Community Mobilization is seen as being the foundation

of the community development process.

Community development seeks to empower individuals

and groups of people by providing these groups with the

skills they need to affect change in their own

communities

Engage the whole community

Facilitate a process of social change thru:

o Awareness

o Support and

o action

Provide repeated exposure to idea

Promote community ownership

Identify the problem(s)

Select a strategy to solve the problem

Community mobilization process

Implementation through the people’s

participation

Assess the results and improve (evaluation)

Identify core areas of community development such as

Health (Maternal and child mortality, HIV/AIDs, Malaria),

women empowerment, Water and Sanitation, etc.

Prepare to mobilize

Identify a common issue that the whole community can get

involved

Gather information about the issue and the community

Identify resources and constraints

This depends on the identified problem and it is likened to

the planning phase

Plan for community dialogue and select a strategy

Some problems –

o require sensitization on the issue.

o call for mobilization of community

o need interaction with individual family members.

A process whereby a group of people become aware

of a shared concern or common need and decide to

take Mobilization in order to create shared benefits.

A continual and cumulative process that involves

communication, education, and organization, which

together lead to community Mobilization and

development.

Community Mobilization linkages Capacity building

Outside Community Group resources Participation

Mobilization Empowerment

Developing an on-going dialogue between

community members

Creating or strengthening community

organizations (Committees etc.)

Creating an environment in which individuals

can empower themselves to address their own

and their community’s needs

Promoting community members’ participation

Some of the actions undertaken by the people to promote

health and prevent diseases include:

Co-operative farming to ensure that the community have

sufficient food of the right kind

They can get together to make the most of whatever

source of water they have ensuring that it is protected from

pollution

They can insist on acceptable standard of hygiene in and

around the homes, in the market places, shops, schools,

etc.

They can ensure that every child in the community are

immunized against the childhood killer diseases

They can fight certain diseases like malaria, and other

communicable diseases by insecticide spraying for the

Evaluation should be carried out

while all these are on,

intermittently to ensure that the

set goals are being met

Revise the strategy wherever

necessary

Increase community, individual, and group

capacity to identify and satisfy their needs

Improve program design, quality, results and

evaluation

Cost effective way to achieve sustainable results

Increase community ownership of the program

Bringing People Together

Building Trust

Encouraging Participation

Facilitating Discussion and Decision-making

Helping Things to Run Smoothly .

Facilitation in community mobilization process

Good communication skills

Good facilitation skills

Good listener

Committed

Decision maker

Active

Negotiation skills

Honest

Known to culture and values of society

Well dress

Catalyst

Management skills

This is the most essential and sensitive part of theprinciples of primary health care.

Enables them to become agents for their own developmentinstead of being passive beneficiaries of development aid.

This is the process by which individuals, families andcommunities assume the responsibility in promoting theirown health and welfare.

Community involvement is a process in which partnership isestablished between government and the local communitiesin planning and implementation of health care activities.

The purpose of this is to help in building local self

reliance and gaining social control over PHC

infrastructure and technology for example: training of

village health workers and aids.

It is important to note that community participation

can not occur without prior mobilization

Individual in the community know their own situation

better and they are motivated to solve common

problems.

An illness due to a specific infectious agent or its toxic

products capable of being directly or indirectly transmitted

from man to man, animal to animal or from the environment

(air, dust, soil, water, food) to man or animal.

Epidemic: occurrence, in a community or region, of a group ofillnesses of a similar nature in excess of normal expectancy

Endemic: habitual presence of a disease or agent within ageographic area based on the usual prevalence of a givendisease within such an area

Pandemic: an epidemic which is worldwide in distribution

Antigenicity: Ability of agent to induce antibody production in thehost (e.g. re-infection with measles virus is very rare).

Carrier: person/animal that harbors a specific infectious agent inthe absence of discernible clinical disease and serves as apotential source of infection

Infectivity: Capacity of agent to enter and multiply in asusceptible host (hence produce infection/disease) (polio andmeasles have high infectivity)

Pathogenicity: Capacity of agent to cause clinical disease in theinfected host (measles has high pathogenicity)

Virulence: The degree of pathogenicity of an infectious agent. i.e.the ability of the agent to invade and damage tissues of the hostcausing severe manifestations or death.

Toxigenicity: The ability of a microbe to produce bio chemicals,known as toxins that disrupt the normal functions of cells or aregenerally destructive to human cells and tissues

A process that begins when an agent leaves its

reservoir or host through a portal of exit, and is

transported by some mode of transmission, then

enters through an appropriate portal of entry to infect a

susceptible host.

Chain (Cycle) of infection

Susceptible Host

Agent

Reservoir

Mode of transmission

Portal of ExitPortal of Entry

• Microorganisms are responsible for disease production

(viruses, bacteria, protozoa, parasites, fungi, etc.

• Agent factors that affect disease transmission:

o Infectivity

o Pathogenicity

o Virulence

o Antigenicity

The reservoir of an agent is the habitat in whichan infectious agent normally lives, grows, andmultiplies.

“any person, animal, arthropod, plant, soil, orsubstance, or a combination of these, in whichan infectious agent normally lives and multiplies,on which it depends primarily for survival, andwhere it reproduces itself in such a manner thatit can be transmitted to a susceptible host.

It is the natural habitat of the infectious agent.”

Portal of exit is the path by which an agent

leaves the source host.

Examples:

• Respiratory tract

• GIT

• Skin and mucous membrane

Mode of transmission

Direct transmission Indirect transmission

Direct contact

Droplet infection

Contact with soil

Inoculation into skin or mucosa

Trans-placental (vertical)

Vehicle-borne

•Vector-borne:•Mechanical•biological

Air-borne

Fomite-born

Unclean hands and fingers

An agent enters a susceptible host through a portal of

entry.

The portal of entry must provide access to tissues in

which the agent can multiply or a toxin can act.

Often, organisms use the same portal to enter a new

host that they use to exit the source host.

A susceptible host is the final link in the chain of infection.

The host is a person or other living organism that can be

infected by an infectious agent under normal conditions.

An infectious agent seeks a susceptible host aiming

“successful parasitism”.

Four stages are required for successful parasitism:

1. Portal of entry

2. Site of election inside the body

3. Portal of exit

4. Survival in external environment

Rapid Assessment

Prevention

Surveillance

Outbreak Control

Disease Management

The objectives should be :

To assess the extent of the emergency and the threat of

communicable diseases in the population

To define the type and size of interventions and priority

activities

To plan the implementation of these activities

To provide information to international community, donors

and the media to mobilize resources both human

and financial

Communicable diseases can beprevented by appropriate preventivemeasures which include:

Good site planning

Provision of basic clinical services

Provision of appropriate shelter

Clean water supply

Sanitation

Mass vaccination against specificdiseases

Regular and sufficient food supply

Control of vectors

Increasing the resistance of the host

Inactivating the agent

Interrupt the chain of infection

Restricting spread of infection

o isolation

o quarantine

o segregation

o personal surveillance

Activities targeted at detecting disease at

earliest possible time to:

o begin treatment

o stop progression

o protect others in the community

Examples of activities: case finding,

health screening, health education

Limits the progression of disability

Treatment of symptoms and

rehabilitation vary with each specific

disease

Surveillance of disease means the exercise of continuous

scrutiny and watchfulness over the distribution and spread

of infections and the related factors, with sufficient

accuracy and completeness to provide the basis for

effective control

The surveillance of communicable diseases has 2 main

objectives:

o Recognition of acute problems that demand immediate

action

o Provide a broad assessment of specific problems in

order to discern long-term trends and epidemiological

patterns, to guide and monitor intervention and to

assess their impact

An outbreak is occurrence of a number of cases of a

disease that is unusually large or unexpected for a given

place and time.

Outbreaks and epidemics refer to the one and same

thing.

Outbreaks in emergency situations can spread rapidly

giving rise to high morbidity and mortality rates.

Aim should be to detect and control the outbreak as

early as possible.

Preparation

Detection

Response

Evaluation

Health coordination meetings

Strong surveillance system

Outbreak response plan for each disease

Stocks of iv fluids, antibiotics and vaccines

Plans for isolation wards

Laboratory support

Surveillance system with early warning system

for epidemic prone diseases.

Inform ministry of health and WHO in case of

outbreaks of specific diseases.

Take appropriate specimens (stool, CSF or

serum) for laboratory confirmation.

Include case in the weekly report.

Confirm the outbreak

Activate the outbreak control team

Investigate the outbreak

Control the outbreak

Assess appropriateness and effectivenessof containment measures.

Assess timelines of outbreak detectionand response.

Change public health policy if indicated.

Write and disseminate outbreak report.

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Adesokan, F.O.O. (2011). Reproductive HealthFor All

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Sagun P. (2014).

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http://www.agius.com/hew/resource/surv.htm

Kulkarni, R. (2014). Control of Communicable Diseases

in Emergencies. Article from: Provincial

Epidemiology and Disease Control Officer, Ministry

of Health and Child Welfare, Zimbabwe.

www.scribd.com/doc/922132/Control-of-Communicable-

Diseases

There is an outbreak of cholera in Alkamawa community,

discuss how health surveillance, community motivation

and participation can be used to control the disease.