Community diagnsis

COMMUNITY DIAGNOSISCDX – PART 2

CM3 2010-2011Department of Family and Community MedicineDe La Salle Health Science CampusEstrella P. Gonzaga M.D.

epgonzaga DFCM DLSHSI 2010

CM3 Program/ Project Management Cycle

P

I/M

E P

I/M

E

PI

SITUATIONAL ANALYSIS

CDX

P

I/M

EHEALTHEDUCATION


CDx in the Program/ Project Management Cycle

CDX1. Plan - CDx Plan

Work PlanEvaluation Plan

2. Conduct3. Reporting

Lit Rev

Step 1: Situational Analysis

Step 2. Objective Setting

Step 3: Action Planning

Step 4. Plan for Evaluation

Problem Investigation

1. Plan – PI PlanWork Plan

Evaluation Plan

2. Conduct3. Reporting


1.2 & 1.3 Plan the Work Activities/ Evaluation

Who will do what and

when? Attained ?

c. Data collection tools

d. Data recording and processing

e. Data analysis

4. Describe report format

What instruments will

be used to measure

the conditions?

b. VariablesWhat will be covered?

3. Identify the Methods

a. Study Population Who will be interviewed?

1. Clarify purpose

2. Identify the objectives

Why is the survey

being done?

1.1 Planning the CDx Planning Survey


ANALYSIS


Planning the analysis

Decisions on

- Coding

- Processing

- Computer

- Manual – Hand tallying

- Hand sorting

- Statistical Analysis

- Dummy Tables (skeleton tables – row and column headings but no figures)

- Statistical Techniquesepgonzaga DFCM DLSHSI 2010

Statistical Analysis

Examine

- each variable separately

- pairs of variables

- sets of three or more variables

-


Statistical Analysis

1. Simple descriptive statistical displays and summaries

- Examine the frequency distribution of all variables

- Summarize e.g. means, %/ rates

* Seek patterns and inconsistencies

2. Relationships between variables

- cross tabulations (Contingency table)

- diagrams e.g. pie, bar, line


HEALTH

STATUS

Popn Social Econ Envr Health Sector

Knowledge/

Perception

STRUCTURE OF DATA CATEGORIES

GENERAL DESCRIPTION


Community Diagnosis Survey Plan 1

DATA CATEGORY(Variables)

DATACOLLECTIONSource/ Tool

DATA ANALYSIS REPORT

GeneralDescription

Records ReviewKey informant interview

Content analysis Report FormatSec 4.1

HEALTH DETERMINANTS

InterviewQuestionnaire

DescriptiveStatistics

Population Sec I- A, #2-5 Frequency Distribution Sec 4.2.1

Sec 4.2.1

Health Status Sec II-A #1,7Sec III-A, B

Frequency Distribution Sec 4.2.2

Sec 4.2.2


Final cdx 09 tools/CHProject REPORT 2009-10 (2).doc

Final cdx 09 tools/CommunitDiagnosisFormRevised-7-1-09 (1).doc















DATA CATEGORY VARIABLES

General Description GeographyClimateTemperatureRoad condition/ How reachedHouseholds – numberHouses spatial arrangementSource of LivelihoodMeans of transportationHealth Resources/ FacilitiesInfrastructure/ Educational/ Sports FacilitiesHistory of BarangayBarangay Council Members

Population AgeSexCivil StatusDependency RatioSex RatioNatural Growth RateVital Indices

DETAILS


Source: NOH 2005-2010 epgonzaga DFCM DLSHSI 2010

Source: Field Statistics Health Information Service

15 – 49 (34)61%

Less than 15(14)

35%

65 over4%

50.4% M

49.6% F

EST.79,503,675.



DATA CATEGORY DATA COLLECTIONSource/ Tool

DATA ANALYSIS

REPORT

Social InterviewQuestionnaireSec I- A # 6-11Sec I-C,D

Frequency Distribution Sec 4.2.3

Sec 4.2.3

Economic Sec 1-B Sec 4.2.4 Sec 4.2.4

Environment Sec I- E Sec 4.2.5 Sec 4.2.5

Health Sector

a. HumanResource

Sec II-A #1,2Sec II-C,#9Sec II-D,#2,7Sec III-A,#6,7,9Sec III-B,#6,7

Sec 4.2.6.1 Sec 4.2.6.1



DATACATEGORY

Variables

Social Number and Type of FamilyHousehold sizeHousehold Head CharacteristicsYears of residence in communityPlace of OriginPlace of Last ResidenceReligionEducational AttainmentMembership in community organization x type x nameDwelling Unit – type of housing material, house ownership, lot ownership, electricity, cooking facility

DETAILS


DATACATEGORY

Variables

Economic Number of Source of IncomeType of Main Occupation by genderType of other source of income by genderTotal monthly incomeby main and other source Income bracketMean, median, mode

Environment Type of water source by distancePractice of boiling waterType of excreta disposalType of garbage disposalType of drainage system

DETAILS


DATA CATEGORY Variables

Health Sector

Human Resource Attendant at birth x PlacePrenatal consult x AOGSource of FP KnowledgeSource of information on FP methodPersons first consulted for illness by Place of consultationEffectiveness of treatment by consulted personCause of death by person consultedReason for non-medical attendance

DETAILS



DATA CATEGORY DATACOLLECTIONSource/ Tool

DATA ANALYSIS REPORT

Knowledge of Primary Health Care

Sec IV Content Analysis Sec 4.2.7

Sec 4.2.7

Perceived Community Health Problems/ Causes/ Solutions

Sec V Content analysis withFrequency DistributionSec 4.2.8

Sec 4.2.8

Perceived Medical Problems/ Causes/ Solutions

Sec VI Content Analysis with Frequency DistributionSec 4.2.9

Sec 4.2.9


DATA CATEGORIES VARIABLES

PHC concepts Knowledge Preventable Diseases, Protein role, Signs of

Normal Pregnancy, Newborn bath and cord care

Breastfeeding / Bottle feeding effect on infant

Health, Immunizable diseases, Covered Child

With fever, Family planning, herbal medicine

Safety, Tuberculosis sign, wound cleaning,

Burning of garbage, Drugs in Hypertension,

Fruits sugar and diabetes

Perceived community Health Health problems, corresponding causes

Problems, Solutions Corresponding solutions

Perceived Medical Problems Medical problems, corresponding causes

Solutions Corresponding solutions

DETAILS


Summary forms

Frequency distribution: one variable, two or more

* Check appropriate Denominators

Quantitative

measures of central tendency

measures of dispersion

Qualitative

rates

ratios epgonzaga DFCM DLSHSI 2010

Rates

e.g. Prevalence

Numerator : No. of HH

of HH Members

reporting sick with fever during a six month period

Denominator: Total number of HHof total Population

Factor: 10, 100, 1,000, 10,000, 100,000


Analysis of problems: 2 of the 5 Q Sec 4.3 (Q1) What is the state of

health of the community?

Statement on the overall health condition of the community based on

Findings on the 4 life events:-- births -- 0-6 nutritional status-- morbidity-- mortality


HEALTH: Vital Events

BIRTH

NUTRITIONAL STATUS

ILLNESS/ DISEASE

DEATH


Sec 4.3 : Health status of the community

Health Events Status

Births

Nutrition, 0-6 y.o.

Morbidity

Mortality


DATA CATEGORY Variables

Health Status 1 year Mortality – RatesCause by Age by SexHouseholds with Deaths

•6 months Morbidity –Prevalence Rates•Cause by Age by Sex•Households with Sick

•Nutritional Status 0 -71 months•Weight by Age by Sex• Height by Age by Sex


Data Processing/ Organization

Causes of Morbidity Cases Prevalence

Fever 15 8.77

Cough 6 3.51

Tonsillitis 4 2.34

Colds 2 1.17

Flu 2 1.17

Dengue 1 0.58

Allergy 1 0.58

Acute

Gastroenteritis

1 0.58

Table 2.2.3 Frequency and prevalence rates of the causes of Morbidity from December 1, 2005 to May 31, 2006 in Bgy. X


Sec 4.4 Q2: “What are the factors responsible for the health condition of the community?

Identification of factors known to affect the particular health condition

Assumption: knowledgeable of event process

logical sequence of conditions (factors) that lead to undesirable event

Presentation types

1. Tabular (Cdx use)

2. Graphical e.g Problem tree (Problem

investigation use)


PREGNANCY0 – 9 mos

DELIVERY

24 HOURS

POSTPARTUM

0 – 6 WEEKS

Family Planning


D:/NOH2005_2010ALL

D:/NOH2005_2010ALL

Total Fertility Rate: Average number of births that woman would have at the end of her reproductive life

Source: National Objectives for Health

Compared to Itself1999:

NCR 2.13East Visayas 4.73

Urban 3Rural 4.7

Mother’s Educationwithout 5.01

Elem 5.0HS 3.6

College 2.9


Source: NOH 2005-2010 p. 207



Sec 4.4: Factors affecting the health status of the community

HEALTH STATUS CORRELATES

Pop SOCIAL ECONO ENV H SERVCS KAP

BIRTH

ILLNESS

NUTRITION

DEATH


HS CORRELATES

P S E Env HHR/HHF K PHC Percept

BirthHigh

CBR

%W

MRA

EducAttain

Mother

HH incom

e

Attendanceat birth by

place

% #3 %HH report

ing problems/

cause

% FP knowledge

No.8 FP

% FP use

% PrenatalConsult



Facility Consulted (simple illness) Freq %

Private hospital/clinic 16 47.1

Government Hospital 0 0

Rural Health center 6 17.6

Community Health Worker 0 0

Self – medication 11 32.4

Others: none 1 2.9

Total 34 100

Table 2.1.1 Frequency and percentage distribution ofhouseholds by type of facility usually consulted

for simple illness in Bgy. X.2005



Facility Consulted Simple Illness Serious

Private hospital/clinic 47.1 73.5

Government Hospital 0 11.8

Rural Health center 17.6 5.9

Community Health Worker 0 2.9

Self – medication 32.4 0

Others: none 2.9 5.9

Total 100 100.0

Table 2.1.1 Frequency and percentage distribution of householdsBy type of facility usually consulted for simple illness in Bgy. X.

2005


Table 6.1 Frequency distribution of perceived

community health problems in Bgy X. 2005

Community Health Problem Frequency %

Garbage 12 35.3

Frequent colds/ cough of children

12 35.3

Mosquitoes 6 17.6

Piggery 5 14.7

Air pollution 4 11.8

Tall grasses 3 8.8

Far from health center 1 2.9

Total HH: 34 Total HH with no answer 10epgonzaga DFCM DLSHSI 2010

PROBLEM Freq/ % CAUSES Freq / % SOLUTION Freq/ %

Diarrhea 10 / 50 Parentsneglect

20/ 100 Teach

Dirtywater

DasmaWater SS

Play in flood

Scold

FLies Garbage City Hall

Rains None

Table 6.2 Frequency distribution of perceived community health problems , causes and solutions in Bgy X. 2005


Sec 4.5 Current efforts about the health situation

Summarizes

- What the community is doing about it

- What the health services is doing about it


Interpreting the Findings

1. “ Make sense of the findings”

- Identify problems

Aspects of community (variables)

in relation to a standard

Problem areas = if below the standard

- Explain causes of the problems


Interpreting the Findings

1. “ Make sense of the findings”

2. ‘Broader significance’ –

extent to which they may be generalized beyond study population,

- wider scientific implications,

- research questions raised or unanswered

- practical implications e.g. provision of medical care or public health action


5. Conclusion

“ Making sense of the Data collected”

4.1 Identification of problems areas

(compare collected data with standards / reference points)


Comparison with Standards /Reference points

1. Acceptable levels - Desired situations

Health goals

2. Within same area –Trends (time)

3. Within country : Municipality; Province / Region National

4. With other countries – Western Pacific

South East Asia


Sources of standards: (CM3 use)1. National Objectives for Health

1999-20042005-2010

2. National Statistical Coordination Board 3. World Health Organization

- World HeaLth Statistics 2010- Country Health Information

4. UNICEF – State of the World Children Report5. Health of Asia and the Pacific


DATA CATEGORY StandardsNational Obj for health, 1999-2005

Findings

PopulationCBR

28.4/ 1000 pop or 2.84%

Health statusNutritional Status

Morbidity TB = 1.9 / 1000Ph 0-6 = 350 / 100,000Polio = 0Measle = < 3,000NT = 1 / 1000 LBDip = <300 casesPerluri = <1,500 casesPavasit = < 50%Diarrhea = 1%HPN = <15%Cancer = 5 / 10,000


DATACategory

STANDARDS(Source/ Year)

CommX

FINDINGS

Population

CBR 23.1/1,000 pop(PHS, 2000)1

18.0/1000

20.50/1,000pop (PHS,2004)2

1. National Objectives for Health, 2005-2010

2.Western Pacific Country Health Information Profiles 2008

DIFFERENT VALUES AMONG

REFERENCES!


Health Stat REf/CHIPS2008.pdf

Health Stat REf/NOH2005_2010ALL

Health Stat REf/CHIPS2008.pdf

Western Pacific Country Health Information Profiles 2008epgonzaga DFCM DLSHSI 2010

Findings

- Comparison between the specific condition in community and the standard/ reference

With in Standard BELOWSTANDARD

Acceptable NOT ACCEPTABLE

Favorable NOT FAVORABLE

BETTER WORSE



WITHIN STANDARD

BELOW STANDARD

VALUES HIGH OR LOW HIGH OR LOW

IMPLICATION ACCEPTABLE NOT ACCEPTABLE

FAVORABLE NOT FAVORABLE

BETTER WORSE

TFR : 2.3 in 2010



Infant Mortality Rate

1998

Urban 30.9

Rural 40.2

Lowest

Metro Manila 23.7

Central Luzon 23.6

Western Visayas 26Highest

Eastern Visayas 60.8

ARMM 55.1

Caraga 53.2



Indonesia: 312 - 385

Philippines :

1970 190

1995 179.7

Malaysia 20

Thailand 10.7

Japan 7.6

Singapore 4.1

MATERNAL DEATHS/ 100,000 LIVE BIRTHS

Source: National Objectives for Healthepgonzaga DFCM DLSHSI 2010

Lowest

Metro Manila

Southern Tagalog

Highest

ARMM

Northern Mindanao

Maternal Deaths: less 1% of total deaths

Source: National Objectives for Healthepgonzaga DFCM DLSHSI 2010

Sec 5.1 : Problem ID

Information Bgy X Standard Findings

Population

Health status

Social

Economic

Environm

Health sector

Health services

Knowledge PHC/ Perceptions


Sec 5.2 Problem Prioritization

WHO criteria for prioritization:

1. Magnitude of the problem

2. Vulnerability to technology

3. Social concern

4. Existing health policy


Magnitude

Severity level of disease or condition

Extent of People affected

- Prevalence

- Incidence

(projected number of new cases)

- Case fatality rate (projected no. of

deaths)

- Worsening trend


Vulnerability to technology

1. Existence of effective technology

2. Feasibility of implementation of technology

3. Geographical application of technology

4. Multiplicity of effects of technology


Social concern

Value attached by community to the Disease/ Condition

- Explicitly expressed as a problem

- % of HH reporting

Check the perceived causes and solutions for the identified problem (correct knowledge/ LOGICAL SEQUENCE)


Existing health policy

1. Presence of an existing policy

2. Relevance of existing health policy to the identified health problem


Prioritization process

Scoring system

1. Prepare a scale (0 to 3; 1-5 )

May have different scales depending on nature of problem

Describe each point in scale –

ensure exclusivity

2. Rate each problem


Sec 5.2.1 WHO criteria for prioritization

Points M V SC HP

0 0- 24 % No vaccine < 25

HH report

None

1 25-34% Vaccine for health

workers

25 - 49

HH

1-3 years

2 35- 50% Vaccine free for

young and old

50 – 74%HH

4-6 years


Sec 5.2.2 : Problem prioritization (Application of criteria)

Prob

-lems

Magnit

-ude

Vulnera-bility to tech

Social concern

Existing health policy

Total score

CBR 1 3 1 3 8

Diarrhea (0-5 years)

3 3 3 3 12


Sec 5.2.3 List of 3 priority problems

PROBLEMS BASIS

1.Diarrhea among 0-5 years

Highest score 12

2. High Birth Rate 2nd highest 8

3. High Below Normal WT 3rd highest 6

From the table of Sec 5.2.2, list the three

priority problems with the highest total

scoresepgonzaga DFCM DLSHSI 2010

Activity Results Persons DateTime

Resources

Accomplishments/ Deviations

Reasons for deviation

Sec 6. WORK PLAN


7. Prepare Report

1. Review the prescribed report format

2. Prepare the draft

3. Get comments (team and preceptor)

4. Finalize the report


Report Format

INTRODUCTION (rationale of project)

I. Situational Analysis

A. Community Diagnosis

B. Problem Investigation

II. Project Plan

III. Project Implementation

IV. Project Evaluation


Report Format



1. Rationale (Purpose)

2. Objectives

(SMART – RESULTS)

3. Methodology

4. Results

5. Conclusion

6. Work Plan / Results

7. Evaluation Plan/ Results


Report FormatI. Situational Analysis


1. Rationale

- clarifies the purpose of doing a community diagnosis




2. Objectives GeneralSpecific -Measurable, Attainable,

REALISTIC, TIME-BOUND

(= RESULTS)




3. Methodology: - descriptive vv analytical

- Population: Total, sample

- Data collection: Interview,

questionnaire, documents /

literature review

- Data processing: manual/ computer

- Data analysis:




4. Results

4.1 General description of place

( follow handout outline)

geography, climate etc




4. Results

4.2 Description of the community

- Population Characteristics

- health status

- socio-economic

- environment

- health sector

- health services

Tabular or graphical

Preceded by a statement

Highlights of table/ graph




4. Results

4.3 Description of status of each life event

- At birth

- Nutritional status

- Morbidity

- Mortality Tabular

1- 2 statements




4. 3 LIFE EVENT STATUS

At birth

Nutritional Status

Morbidity

Mortality




4. 4. Factors affecting Life Event

LIFE EVENT CORRELATES

At birth

Nutritional Status

Morbidity

Mortality




4. 5. Description of Current Efforts about the

Health Situation by the Community and

Health Services




5. Conclusion

5.1 Identified Problems (a. detailed list)

Information Standards Comm X Findings

Population

Health Status

Socio -econ

Environment

Health Sector




5. Conclusion

5.1 b. Table on Problems and Basis

Problems Basis




5. Conclusion

5.2 Problem Prioritization

- Using WHO criteria, assign points for each criterion and basis for points

- Prioritize the identified health problems using your developed point system for the WHO criteria


Sec 5.2.1 WHO criteria for prioritization

Points M V SC HP

0 20 - 25 % No tech < 10

HH report

Plenty of children

None

1 26 – 30% Available

Minimal

risk

11 – 19

HH

Existing

Less 5 years

2 31- 35% Wide use

Multiple

effect

20 – 34HH

5 - 10 years

use




5. Conclusion


Prob M V SC EP Total

P1

P2

Pn



A. Community Diagnosis 5. Conclusion


Priority Problem Basis

Problem 1

Problem 2

Problem 3


6. Monitor the activities

Use the

- CDx plan

field editing to ensure reliable and valid results

- Work plan

ensure smooth implementation of activities and provide support to team

members

(PURPOSE OF PRECEPTORIALS)


1.3 Prepare CDx Work Plan (CM3)

Activities/

subactivities

Results Person DateTime Resources

Plan survey CDx Plan

Work Plan

Evaln Plan

Team

Paper

-……..

Conduct

-Collection

CDx Report July 20/ 21

-Processing

-Analysis

Evaluate

Knowledge

Skills

Student

Leader

Peer

June 13

July 22- 30

Exams

Grading sheets


8. Evaluate the CDx

Use the evaluation plan

- attainment of objectives

- efficiency of methods


1.2. Prepare Evaluation Plan

Activities/

subactivities

Results Person Date/Time Resources

Pepare evaluation design

Objectives

Methods defined

June 1- 6 Papers

Handout

Conduct of data gathering

Activities and data gathered

June 14-16 Observation sheets

Data analysis

Responses organized / analyzed

January 30 Papers, computer

Report preparation

Oral and Written reports

Feb 1-15 Papers, computer, printing


Activity Results Persons DateTime

Resources

Accomplishments/ Deviations

Reasons for deviation

Sec 7. EVALUATION PLAN


7. Feedback to the community

Provide community copy of the report

Present results to community

---confidentiality of data must be respected--

feedback must be population rates and not at the individual levels.


CDx in the Program/ Project Management

Cycle

Phase 1: PlanningStep1. Situational Analysis

Community Diagnosis (broad)

Problem Investigation (specific)Step 2. Objective SettingStep 3. Action PlanningStep 4. Plan for Evaluation

Phase 2: Implementation Phase 3: Evaluation


WHAT NEXT !



31 hours work

End point: 3 priority problems

B. Problem Investigation

II. Project Plan

III. Project Implementation

IV. Project Evaluation

Dr. J. Carnate


References1. Kark, Sidney: The Practice of Community –Oriented Primary Health Care. Appleton, Century Crofts,

New York. 1981. P. 112. Ibid. p. 253. Abramson. J.H. Survey Methods in Community

Medicine. 4th edition. Churchill Livingstone. Edinburgh London Melbourne and New York 1990.

p.3154. Presentation format/ content adapted from Dr. Carmen Tolabing’s powerpoint and materials 2005-

2006


Documents

Community diagnsis