Community Diagnosis

FAMILY AND COMMUNITY MEDICINE (3rd Shifting) | (Dr. Rouema Peralta-Perez) | (1 March 2019)

OUTLINE • Involves translation of information collected from community

I. The Community B. Classification of Indicators analysis into formal statements describing health related
A. Community VI. Levels of Analyses of the resources and needs within the community thereby identifying the
B. Community Core Result of the Survey unmet needs of the target population.
C. Eight Subsystems A. Analysis of the Population → It’s not enough that you have the number of respondents, how
II. Community Diagnosis B. Analysis of the Health do they respond, but how you would translate it for community
A. Process Status analysis into formal statements.
B. Goals C. Analysis of Related Socio- → E.g. data from surveys and medical records presented in
C. How is the community Economic Factors community profile documents
diagnosed? D. Analysis of the Health
D. Ecomap Sector A. PROCESS
E. Ecological Approach E. Analysis of the Health • A means of examining aggregate and social statistics in addition to
III. Activities in Community Study Facilities the knowledge of the local situation in order to determine the
IV. Community Analysis VII. References present and future health needs of the community.
V. Health Indicators VIII. Appendix
B. GOALS
A. Characteristics of
Indicators • Analyze the health status of the community;
• Evaluate the health resources, services and systems of care within
the community; – what’s available on them; where do they get
I. THE COMMUNITY
their health services
Community • Assess attitudes toward community health services and issues;
• Cluster of people with common characteristic (geographic (Health-seeking behavior). – Measles outbreak; Anti-vaxxx people
location, occupation, ethnicity, housing condition, etc.); → lack of education on vaccination
• Group of people with common interest living together within a • Identify priorities, establish goals and determine courses of action
larger society; to improve the health status of the community;
→ E.g. common ideology; fishing and farming communities. • Establish an epidemiologic baseline for measuring improvement
• Composed of families; over time.
• Whole entity that functions because of interdependence of its
C. HOW IS THE COMMUNITY DIAGNOSED?
parts/subsystems.
• Collection of data (interviews, questionnaires, observations/
Community Core
participant observations)
• History, sociodemographic characteristics, vital statistics,
• Collation & classification of data;
values/beliefs/religion;
• Presentation of data;
• How the community has evolved through time. From this, we can
• Analysis & interpretation of data;
understand the different relationships the community has.
• Problem identification & explanation;
Eight Subsystems • Action program.
• Physical environment;
• Education; C. ECOMAP
• Safety and transportation;
• Politics and government;
• Health and social services;
• Communication;
• Economics;
• Recreation.

II. COMMUNITY DIAGNOSIS

• Generally refers to identification and quantification of health

problems in a community as a whole in terms of mortality and
morbidity rates and ratios, and identification of their correlates
Figure 1. Ecomap on Community Diagnosis
for the purpose of defining those at risk or those in need of health
• Family – basic unity of the community; Within the family, you
care;
identify the areas or sources of health care.
→ Correlates factors which contribute to the occurrence of health
• Municipal Government – source of budget
diseases; aka underlying causes.
• NGO/Volunteer Groups – source of manpower
→ In the slums of Tondo, Manila where the life is very poor and
• Church – spiritual
very sad – CatReyanna Gray ©
• Local Hospital – a bar in the ecomap on the local hospital may be
• Diagnosing the health status of the community considers the a)
due to inaccessibility of the hospital or if the community has good
population, b) health sector, and c) health-related socio-
primary health care, there will be lesser chances of hospital
economic and environmental factors;
admissions for treatment.

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 D. ECOLOGICAL APPROACH 4. Specific: They should reflect changes only in the situation
concerned.
5. Feasible: They should have the ability to obtain data needed.
6. Relevant: They should contribute to the understanding of the
phenomenon of interest.

B. CLASSIFICATION OF INDICATORS
• Mortality Indicators – IMR, MMR, Post-neonatal, Neonatal, etc.
• Morbidity Indicators – Incidence or prevalence
• Disability Rates
• Nutritional status indicators – BMI, Malnutrition
• Healthcare delivery indicators – “how many is to…”
• Utilization rates – vaccines
• Indications of social and mental health
• Environmental
• Socio-economic
• Health Policy
• Indicators of quality life
• Other indicators

VI. LEVELS OF ANALYSIS OF THE RESULT OF THE SURVEY

A. ANALYSIS OF THE POPULATION

• Total population and geographic distribution
• Age and sex structure (population pyramid)
• Selected vital indices
• Population projection
Figure 2. Ecological Approach on Community Diagnosis
*Primary health care elements daw kasama sa exam. #LamNaDis B. ANALYSIS OF THE HEALTH STATUS
• Leading causes of mortality
III. ACTIVITIES IN THE COMMUNITY STUDY • Leading causes of morbidity
• Leading causes of infant mortality
• Gathering of secondary data;
• Interviews; • Leading causes of maternal mortality
• Questionnaires; • Leading causes of hospital admission
• Observations – environmental factors; • Leading causes of consultation
• Participant observations; • All of these can be obtained from the health centers. But for you to analyze
the community, you can ask the people living in the community, they’ll have
• Records review – in the health centers, local clinics.
the same answers

IV. COMMUNITY ANALYSIS Mortality Indicators

• Mortality Rates
• Process of examining data to define needs, strengths, barriers, → The traditional measures of health status
opportunities, readiness and resources; → Widely used because of their ready availability (death certificate is a
→ Needs – depend on the perception of an expert; legal requirement in many countries).
→ Strengths & Weaknesses – innate/internal in the community; • Crude death rates
→ Opportunities – coming from outside of the community; • Specific death rates: according to age/disease
• Product of community analysis: “community profile”; • Expectation of life
• Analyzing assessment data is helpful to categorize the data. This • Infant mortality rate
may be done as follows: • Maternal mortality rate
→ Demographic (age, gender); • Proportionate mortality ratio
→ Environmental (urban/rural);
• Case fatality rate
→ Socio-economic;
→ Health resources and services; Morbidity Indicators
→ Health policies; • Morbidity rates – data on morbidity are preferable, although
→ Study of target groups. often difficult to obtain
→ Lack of data because health care system is not utilized
V. HEALTH INDICATORS • Incidence and prevalence
• Notification rates
A. CHARACTERISTICS OF INDICATORS • Attendance rate: out-patient clinics or health centers
1. Valid: They should actually measure what they are supposed to • Admission and discharge rates
→ Pwede sa hospital. To diagnose a certain barangay, you identify which
measure; E.g. In diarrhea, proportion of family who has sanitary facilities.
patient comes from the certain barangay
2. Reliable and Objective: The answers should be the same if
→ E.g. Brgy. 657 pinakamalapit na hospital ay Seamen’s Hospital, pero
measured by different people in different circumstances. hindi naman sila doon nagpapacheckup. Yung iba nagpupunta pa ng
3. Sensitive: They should be profound to changes in the situation OM, so you identify sinu-sino yung naadmit from the brgy.
concerned. • Hospital stay duration

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 Disability Indicators → The proportion of people having access to safe water and
• Disability rates sanitation facilities
→ No. of days of restricted activity → Vectors density
▪ Sometimes patients can go back to the recovery phase • Safe water supply
▪ Disabled only for a number of days • Human waste disposal
→ Bed disability days • Industrial waste disposal
▪ Computation usually used for hospitals • Food establishments
▪ For community diagnosis, indices are used (mortality rates • Nutritional
etc.) – it depends how you define a community
→ Work/school loss days within a specified period D. ANALYSIS OF THE HEALTH SECTOR
→ Expectation of life free of disability • Components of the health sector
→ Who comprises the health sector? Decentralized na for the
Nutritional Status Indicators
local government
• Indicator of positive health ▪ In Manila: Manila health department under which are all the health
• Anthropometrics measurements – height and weight centers
• Height of children at school entry • Study of the intersectoral relationship – between the health
• Prevalence of low birth weight sector and other sectors i.e. DPWH, DSWD, MWSS, MMDA;
• Clinical surveys: anemia, hypothyroidism, night blindness • Analysis of the intrasectoral relationship – within the health
• Malnutrition status: stunted, wasted, underweight sector
→ Also includes obesity as malnutrition
E. ANALYSIS OF THE HEALTH FACILITIES
C. ANALYSIS OF RELATED SOCIOECONOMIC FACTORS • Hospitals (are there hospitals near the community?)
• Economic Indices: employment, income • Health units (what are the health units available?)
→ To know the financial capacity of the family/community to • Health manpower (how many doctors are there for the community?)
avail medical services • Expenditure on health
→ To know whether the basic needs of the family could be met • Inventory of health projects and assessment of their
→ To know the needed subsidy/budget allocation of the results/status.
government to provide for the services that the poor wouldn’t Health Care Delivery Indicators
be able to pay for. • Reflect the equity/provision of health care
• Social Indices: education, housing, electrification • Doctor/population ratio
→ Education – To be able to know what level of educational • Doctor/nurse ratio
campaign you will be doing based on their capacity to
• Population/bed ratio
understand information
• Population/per health center
→ Electrification – For the ventilation, and food storage of the
• Basta yung how many is to what (yung pag deliver ng health care)
family/community.
Utilization Indicators
Socioeconomic Indicators
• Health Care Utilization Rates
• Is not a direct measure of health status
• Extent of use of health services
→ Life of poverty does not completely guarantee disease
▪ Though a lot of them still could not afford to avail for health care
• Can be applied to vaccines
→ Being rich does not exempt people from disease • Drugs being procured
▪ Lifestyle diseases/ non communicable diseases • Proportion of people in need of service who actually receive it in
− Could afford buffets and junkfoods a given period
• For interpretation of health care indicators: • Proportion of infants who are fully immunized in the 1st year of
→ Rate of population increase life, i.e. immunization coverage
→ Per capita GNP – to know if the government can provide for • Proportion of pregnant women who receive antenatal care(ANC)
the health services • Hospital beds occupancy rate
→ Level of unemployment • Hospital beds turn-over ratio
→ Literacy rates – higher in females (because they are usually the Health Policy Indicators
primary caregivers) • Allocation of adequate resources
→ Family size • Proportion of GNP spent on health services
→ Housing conditions: no. of persons per room → Budget on health is around 3% (1-3 pesos per person)
▪ Ease of transmission of communicable diseases → Universal Health Care will not be immediately implemented
▪ PhilHealth has two years
NTK: Short film about socioeconomic indicators related to health:
• Proportion of GNP spent on health related activities
Rosario
Rosario is the youngest child in the family with four siblings. Her • Proportion of total health resources devoted to primary health
father was a construction worker and her mother was a housewife. She care
wasn’t breastfed, instead, she had diluted condensed milk. In their Other Health Indicators
community, there was only one private doctor who can attend to their
medical attentions. They do not have sufficient money to admit Rosario • Indicators of quality of life
into the hospital. Rosario died from complications of measles because • Basic needs indicators
her mother doesn’t believe in vaccines. • Health for all indicators

Environmental Indices V. REFERENCES

• Reflect the quality of environment Dr. Perez’ Lecture PPT, Lecture Recordings, 2021B Trans
→ Measures of pollution SINIKSIK KO NA, SAYANG PAPEL. HAPPY SHIFTINGS MGA KA-JEMOGRAPHICS!

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