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 24.63
Rate
Per 1000
population
Crude Death 5.66; 4.8 in
Rate per 1000 1998
population
Infant Mortality 29 per 1000 live
Rate births
Maternal 138 per 1000
Mortality Rate live births
Total Fertility 3.5
Rate
 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
 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
 5 Year Average (2000-2004) 2005*
CAUSE
No. Rate No. Rate
1. Acute Lower RTI
694,209 884.6 690,566 809.9
and 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
43,945 56.2 43,898 51.5
Heart
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 BOTH SEXES
CAUSE
Rate** Rate** Number Rate*
1. Acute Lower RTI
888.8 868.0 776,562 929.4
and 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
38.5 45.1 37,092 44.4
Heart
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 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

 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 -
 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
 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
 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
 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
 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
 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 long-
term 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 leader-
oriented. 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