COPAR Modified

8/9/2019 COPAR Modified

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Ailyn Brillo Pineda


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Community Health Nursing Practice Utilizing COPAR


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y Dr. Alberto Romualdez, former DOH secretary describedthe Philippine health status as on continuing shifttowards positive change despite age-old problems..y Some infectious degenerative diseases are on the rise

y Correlation of poor health with low socio-economic status iswell documented

y Filipinos are still living in the remote areas, where it isdifficult to deliver the health services they need

y Scarcity and exodus of MDs, RNs and RMs add to the poordelivery of the health care to the poor and deprived whocomprise the majority of the countrys 80 million or so totalpopulation


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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 1000population

24.63

Crude Death Rateper 1000population

5.66; 4.8 in 1998

Infant Mortality

Rate

29 per 1000 live

births

Maternal MortalityRate

138 per 1000 livebirths

Total Fertility Rate 3.5


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AgeFemale 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 PopulationProjections: National Statistics Office


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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

C ARAGA

Foreign Countries 114

Residence not stated -

C ARAGA

Source: Philippine Health Statistics, 2000


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CAUSE5 Year Average (2000-2004) 2005*

No. Rate No. Rate

1. Acute Lower RTI and

Pneumonia694,209 884.6 690,566 809.9

2. Bronchitis/

Bronchiolitis669,800 854.7 616,041 722.5

3. Acute WateryDiarrhea

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


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CAUSEMALE FEMALE BOTH SEXES

Rate** Rate** Number Rate*

1. Acute Lower RTI and

Pneumonia888.8 868.0 776,562 929.4

2. Bronchitis/

Bronchiolitis651.8 817.1 719,982 861.6

3. Acute Watery

Diarrhea

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


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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 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


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AREA Fetal Deaths

Philippines 10,360NCR (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) 2,253Region 5 (Bicol) 620

Region 6 (Western Visayas) 699


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 -


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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

hemorrhage263 0.2 15.2

4. Pregnancy with

abortive outcome138 0.1 8.0

5. Hemorrhage in

early pregnancy2 0.0 0.1


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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

9. Intrauterine hypoxia and birthasphyxia

971 0.6 4.5

10.Diarrhea and gastro-enterities of

presumed infectious origin900 0.5 4.2

Infant Mortality: Ten (10) Leading Causes

Number & Rate/1000 Live births & Percentage Distribution

Philippines, 2005


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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

system50,886 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

10. Nephritis, nephrotic

syndrome and nephrosis9.166 11.5 11,056 3.6


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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 period7,385 17.2

10. Nephritis, nephrotic syndrome and

nephrosis6,548 15.3


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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 period4,983 11.8

10. Nephritis, nephrotic syndrome and

nephrosis4,508 10.6


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y Based on these statistics what are the challenges thatnurses, doctors or midwives and other health agencies facein relation to health profile and growth rate of thePhilippine population?

y

What preventive measures can be done?y What can be done to promote and restore health?y What health education can be administered by the

community health workers, doctors, nurses, midwives,etc.?

y How can we improve the health care deliver system?y How can increase the number of health workers?y What can be done for people in the far flung areas to

prevent the occurrence of diseases and health hazards?


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Community Health Organizing Utilizing COPAR


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y Was developed and sponsored by the PhilippineCenter for Population and Development (PCPD)

y To make health services available and accessible to

depressed and underserved communities in thePhilippines

y PCPD is a non-stock, non-profit institution, whichserves as a resource center assisting institutions and

agencies through programs and projects geared towardthe social human development of rural and urbancommunities

y Formerly known as The Population Center Foundation


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y HRDP Iy Trained the faculty, medical/nursing students to provide

health care services to the far flung barrios because oflack of man power for health services at the same timethat similar activities fulfilled the curricularrequirements of the students for public health

y The PCPD provides seed money for the incomegenerating projects

y The CO uses his/her own strategy or method indeveloping the community

y Short-term service


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y HRDP IIy The 2nd cycle uses the same strategy but the program

could not be sustained by the schools or hospitals andthe income-generating projects eventually become thehindrance to the goal of achieving the health programbecause the people tend to be more interested in theincome generated by the projects

y Both HRDP I and HRDP II have brought about some

changes in the community life of the peopley Established basic health infrastructure; basic health

services were increased; there were trained workers andorganized health groups to take care of the needs of thecommunity


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y HRDP IIIy PCPD refined the program and resulted to what is now

called HRDP III, which has these unique features:y Comprehensive training of the staff and faculty of the

participating agency in which the community work wasinitiated

y Periodic training program and regular assistance to theparticipating agency were provided to strengthen the healthoutreach program to become community oriented

y PHC as the approach with which all nursing/medicalstudents, theirCIs and indigenous health workers are trainedfor community health work and around which all otherproject inputs will revolve


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y Community organizing as the main strategy to beemployed in preparing the communities to develop theircommunity health care systems and the establishmentof community health organization to manage the

community health programsy Organizing work in the communities were done in 3

phases

y PAR as fascinating strategy for maximum community

involvement through collective identification andanalysis of community health problems and collectivehealth action

y Available funds to finance community initiated projects


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y Since Management Leadership and Jurisprudence arecourses taught in the classroom members of this groupof students were trained to manage and acts as leaders

of the different levels of the students who wereinvolved in COPAR

y Principles of management were applied in carrying outprimary health care

y The community members, CHWs and leaders wereempowered to manage their own health projects

y Conducted seminars and trainings as well as healtheducation and services needed bycommunity(exposure and immersion 6-8 weeks)


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yA social development approachthat aims to transform the

apathetic, individualistic andvoiceless poor into dynamic,participatory and politically

responsive community.


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yA collective, participatory, transformative,liberative, sustained and systematicprocess of building peoples organizations

by mobilizing and enhancing thecapabilities and resources of the people forthe resolution of their issues and concernstowards effecting change in their existing

oppressive and exploitative conditions(1994 National Rural Conference)


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yA process by which a communityidentifies its needs and objectives,

develops confidence to take action inrespect to them and in doing so,extends and develops cooperative andcollaborative attitudes and practices inthe community (Ross 1967)


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y A continuous and sustained process of educating thepeople to understand and develop their criticalawareness of their existing condition, working with thepeople collectively and efficiently on their immediate

and long-term problems, and mobilizing the people todevelop their capability and readiness to respond andtake action on their immediate needs towards solvingtheir long-term problems (CO: A manual ofexperience, PCPD)


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y 1. COPARis an important tool for communitydevelopment and people empowerment as thishelps the community workers to generate

community participation in developmentactivities.

y 2. COPARprepares people/clients to eventuallytake over the management of a development

programs in the future.y 3. COPARmaximizes community participation

and involvement; community resources aremobilized for community services.


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y People, especially the most oppressed, exploited anddeprived sectors are open to change, have the capacity tochange and are able to bring about change.

y COPARshould be based on the interest of the poorestsectors of society

y COPARshould lead to a self-reliant community andsociety.


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y A progressive cycle ofaction-reflection actionwhichbegins with small, local and concrete issues identified bythe people and the evaluation and the reflection of and onthe action taken by them.

y Consciousness- raising through experimental learningcentral to the COPAR process because it places emphasison learning that emerges from concrete action and whichenriches succeeding action.

y COPAR is participatory and mass-based because it isprimarily directed towards and biased in favor of the poor,the powerless and oppressed.

y COPAR is group-centered and not leader-oriented.Leaders are identified, emerge and are tested throughaction rather than appointed or selected by some externalforce or entity.


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y 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 actualoutputs, activities and strategies and time spent for it

Activities includeCommunity consultations/dialogues

Setting of issues/ considerations related to site selection

Development of criteria for site selection Site selection

Preliminary social investigation (PSI)

Networking with LGUs, NGOs and other departments


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y Entry Phase Social preparation phaseActivities done here includes:

Integration with the community Sensitization of the community; information campaignsContinuing social investigationCore group formation: Development of criteria for the selection ofCG members Defining the roles/functions/tasks of the CG

Coordination /dialogue/consultation with other communityorganizations

Self-awareness and Leadership training (SALT), action,planning

This phase signals the actual entry of the communityworker/organizer into the community


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y Community Study/Diagnosis Phase (Research Phase)y Selection of the research team

y Training on the data collection methods and techniques;capability-building (includes development of data collection

tools)y Planning for the actual gathering of the data

y Data gathering

y Training on data validation (includes tabulation andpreliminary analysis of data)

y Community validationy Presentation of the community

study/diagnosis/recommendations

y Prioritization of community needs/problems for action


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y Community meetings to draw up guidelines for theorganizations of the CHO

y Election of officersy Development of management systems and procedures,

including delineation of the roles, functions and task ofofficers and members of the CHOy Team building/Action-Reflect Action (ARA)y Working out legal requirements for the establishment of

the CHOy Organization of the working committees and task

groups(e.g. education and training, membership ofcommittees)

y Training of the CHO officers/community leaders


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y Community Action Phasey Organization and training of the community health

workers (CHWs)y Development of criteria for the selection ofCHWs

y Selection ofCHWs

y Training ofCHWs

y Setting up of linkages/network referral systems

y Initial identification and implementation of resource

mobilization schemes


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y Sustenance and strengthening phasey Occurs when the community organization has already

been established and the community members arealready actively participating in community-wideundertakings

y Strategies used may include:y Education and training

y Networking and linkages

y C

onduct of mobilization on health and developmentconcerns

y Implementation of livelihood projects

y Developing secondary leaders


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Activities in Building Peoples Organization


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y ACO becoming a par with the people in order to:y Immerse himself in the poor communityy Understand deeply the culture, leaders, history, rhythms

and lifestyle in the community

y Methods of Integration includes:y Participation in direct production activities of the

peopley Conduct of house visitsy Participation in activities like birthdays, fiestas, wakes,

etcy Conversing with people where they usually gather such

as stores, water, walls, washing streams, or churchyardsy Helping out in the household chores like cooking,

washing the dishes, etc


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y A systematic process of collecting, collating, analyzing data todraw a clear picture of the community

y Also known as the COMMUNITY STUDYy Pointers for the conduct of SOCIAL INVESTIGATION

y Use of survey or questionnaires is discouragedy Community leaders can be trained to initially assist the community

worker/organizer in SIy Data can be more effectively and efficiently collected through

informal methods-house visits, participating in conversations injeepneys and others

y Secondary data should be thoroughly examined because much ofthe information might already be available

y SI is facilitated if the CO/ community worker is properly integratedand has acquired the trust of the people

y Confirmation and validation of community data should be doneregularly


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yCO choose one issue to work in orderto begin organizing the people


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y Going around and motivating the people onan one on one basis to do something on theissue that has been chosen


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y People collectively ratifying what they have alreadydecided individually

y The meeting gives the people the collective power and

confidencey Problems and issues are discussed


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y Means to act out the meeting that will takeplace between the leaders of the people andgovernment representatives

y It is a way of training the people toparticipate what will happen and preparethemselves for such eventually


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yActual experience of the people inconfronting the powerful and the

actual exercise of the people power


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y The people reviewing the steps 1-7 so to determinewhether they were successful or not in their objectives


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y Dealing with deeper, on going concerns to look at thepositive values CO is trying to build in theorganization

y

It gives the people time to reflect on the stark reality oflife compared to the ideal


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y The peoples organization is the result of manysuccessive and similar actions of the people

y A final organizational structure is set up with elected

officers and supporting members

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