1

FAVOUR SCHOOL OF HEALTH TECHNOLOGY,

IKOM CROSS RIVER STATE

LECTURE NOTE

ON

SUPERVISED COMMUNITY BASED

EXPERIENCE

FOR

COMMUNITY HEALTH EXTENSION WORKERS (CHEW)

COMPILED BY:
EKU, OMOM OBAJI
(RCHEW, RCHO, PHCT, [Link] PUBLIC HEALTH, BSCEDHE, [Link] COMMUNITY HEALTH IN
VIEW.)
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CONCEPT OF COMMUNITY MOBILISATION

INTRODUCTION

Community Mobilization has been defined as a capacity building process through which
community individuals, groups, or organization’s plan, carry out and evaluate activities on
a participatory and sustained basis to improve health and other needs on their own
initiative or stimulated by others. This process must involve the whole community, not just
the specific actors who are directly involved in the intervention programme.

A community could be considered “mobilized” when all members feel as though the issue
is important to them and worthy of action and support. Community mobilization inherently
involves community engagement and partnership which are the universally-identified key
components to success. These key components include recruiting community members to
participate in needs assessments, convening advisory boards comprised of multiple
constituencies within a community, empowering community members to carry out chosen
intervention strategies and evaluation endeavors, and recruiting community members to
occupy leadership positions within the prevention effort.

Community mobilization is important because the community itself is ultimately

responsible for and affected by situations of safety or insecurity.
Government resources are insufficient to meet the entire health needs of all the people.
But even where Government has all the resources available, the appreciation of the
people and their willingness to use these resources must be aroused for the fullest
exploitation of and benefit from deployed resources. Community mobilization is
directed at stimulating people to be aware of what they can do by and for themselves to
improve their health and solve some of their health problems. In any case, we should
take a look at the objectives as indicated below.

Definition of a Community

The World Health Organization (1978) stated that a community consists of people living
together in some form of social organization and cohesion. Its members share in varying
degree political, economic, social and cultural characteristics, as well as interests and
aspirations including health. Communities vary widely in size and socio-economic
profile, ranging from clusters of isolated homesteads to more organized villages, towns
and cities. Olise (2007) defined a community as a group of people living in a defined
area and sharing some common interest. Examples are towns and villages.

A community can be homogenous that is consisting of people sharing the same culture
e.g villages or heterogeneous that is consisting of people sharing different culture e.g
urban cities.

You can see the different ways a community is defined. Each of these definitions
expresses the idea of living together in a specified area and sharing things in common.
"Community" is important within a public health context. Research demonstrates that:

• Prevention and intervention take place at the community level.

• Community context is an important determinant of health outcomes.
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However, the lack of a commonly accepted definition of community results in different

collaborators forming contradictory or incompatible assumptions about community. This
often undermines their ability to evaluate the contribution of the community in achieving
in December 2001; the American Journal of Public Health published the results of research
to define community within a public health context.

Researchers identified core dimensions of "community," as defined by people from diverse

groups. Five core elements emerged:

• locus
• sharing
• action
• ties, and
• diversity

A common definition of community emerged:

A group of people with diverse characteristics who are linked by social ties, share common
perspectives, and engage in joint action in geographical locations or setting (Mac Queen et
al. 2001).

Description of the Organizational Structure of a Community

Organizational structure of a community refers to how a community is made up as well as

who is at what position otherwise known as the leadership structure.

The structure is as follows:

1. Village Head (Paramount Ruler)

2. Village Council(Chiefs)
3. President/Chairman (Community Development Committee)
4. Influential leaders
5. Members of the Community (the people)
This structure enables community mobilizes to know where to start from in the
communities in their mobilization processes.

Description of the Leadership Composition of Community

There are different group of leaders in the community. They include:

Formal Leaders
These are the first class individuals otherwise known as ceremonial leaders in the
community who are elected, appointed or chosen to rule the community e.g. traditional
rulers namely Chiefs, Ezes, Obas, Emirs, Districts heads and village heads. They are
entitled to remuneration from government.

Informal Leaders
These leaders are unofficially installed but nominated and recognized by members of
the community to lead them in their day to day activities. For example women leaders,
market women leaders, youth leaders, men leaders etc.
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Opinion Leaders

These are persons authorized and recognized by constituted authorities to give opinions
on various matters concerning the community. They are appointed to hold offices
especially in public bodies and organizations. For example; chairmen of councils,
councilors, pastors, Imams etc. Opinion leaders constitute the leadership composition of
a community. They represent a cross-section of the community in matters of decision
making.
Rationale for community mobilization

Rationale for community mobilization simply means the fundamental reasons or ideas
behind community mobilization. Since community mobilization is an important activity
in health care delivery it must have some rationale behind it. In this unit, we are going to
be discussing the importance of community mobilization and its key elements.

Definition of Community Mobilization

Federal Ministry of Health (FMOH) (2004) defined community mobilization as a means

of encouraging, influencing and arousing interest of people to make them actively
involved in finding solutions to some of their own problems. Community Mobilization
is getting people involved and committed to achieving goal. Onuzuluike (2004) defined
community mobilization as process of assisting people to become more aware of their
community, take an in-depth look at that community, identify the felt needs as well as
their needs, have belief or faith that something can be done to relieve these needs and
that most of there sources to achieve these are within the competence of the community,
possess a desire and a willingness to use such resources to ensure the continued
existence and improvement of their community. Gbefwi (2004) stated that community
mobilization involves creating awareness on health conditions and allowing for a
common solution in the community.

It is an ideal method for developing decision-making skills, communication, co-

operation and self reliance. Community mobilization simply implies putting a community
in a state of readiness for action. It requires time, patience and understanding on the part of
the health workers in order to achieve success. This is not a one time activity, but rather, a
continuous exercise, which should constitute an integral aspect of efforts, aimed at
initiating health action by the people them selves. You will observe that in the different
definitions of community mobilization the focus has been on creating awareness for the
community to take decision involving some of their health problems.

Community mobilization has been defined as a capacity building process through which
community individuals, groups, or organizations plan, carry out and evaluate activities on
a participatory and sustained basis to improve health and other needs on their own
initiative or stimulated by others (Howard-Graham, 2005).Mobilization increases the
participatory decision-making processes by bringing diverse stakeholders to the table. It
enables those people who may not normally be involved in the decision making process to
be a part of the project. Mobilization also fosters strong relationships between Federal
governments, local governments, businesses and community members.

Community mobilization strengthens and enhances the ability of communities to work

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together to achieve goals that are important for that community. Community mobilization
is not something that is done over night, but it is a process that requires time and
commitment from all parties involved. The key to successful mobilisation efforts is
making sure that communities are in the driver’s seat during the process. Mobilisation is
not something that happens to the community rather it is something that the community
does. One of the primary goals of mobilization is to make sure mobilization efforts are
community driven. This allows a community to solve its problems through its own efforts
which is the key to having sustained outcomes within a community.
Goals of Community Mobilisation

• Increase community, individual, and group capacity to identify and satisfy needs
• Increase community level decision-making
• Increase community ownership of programs
• Bring additional resources to the community
• Build on social networks to spread support, commitment and changes in
social norms and behaviours

Rationale for Community Mobilisation

A community mobilisation approach is valuable because it empowers people’s rights to

participate and to determine their own future. It enables groups to create local solutions to
local problems. These local solutions will be more sustainable than external solutions that
do not fit well with the local situation, culture and practices. When communities define the
problem, set common goals and work together on their own programs, to achieve the goals,
the communities change in ways that will last after the project ends (Florida Department of
Health, 2016).

The discussions on the rationale for community mobilisation are as follows:

The rationale is that when people are actively mobilized and committed in taking part in
matters concerning them and their health right from the planning stage, they will take part
in the implementation and evaluation processes.

It has been proved that when health projects are initiated from outside, nobody is interested
in taking good care of such facilities but when the people are involved in such projects
greater care is taken by the community.

It is known that mobilization activity depends on sensitisation through adequate flow

of information. Therefore, instead of any Health Agency to present the community with
ready-made solutions on all the health problems, the community is encouraged to take a
look at its own problems and find solutions to some of them using its own resources and
local organisation. However, outside assistance may be provided through advice, materials
and finance.

It is observed that rural or community development/health programmes that do not

recognise the initiatives and the ingenuity of the people are unlikely to achieve its stated
objectives. Thus, community mobilization is therefore expedient for the stated objectives
of any health programmes in the community to be achieved.

One of the rationales for community mobilisation is that it establishes cordial relationship
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and understanding between the health workers and the community in areas of traditional
beliefs and cultural values.

Community mobilization enables the com munity to develop link with different
organisations. This inter-sectoral collaboration assists the community in times of need. The
rationale for community mobilisation also include the idea of teaching the community how
to solve some of their health development programmes within themselves and not always
waiting for Government to do everything for them.

From the above stated facts you can understand the rationale or the idea behind community
mobilisation in health care delivery as it is pre-requisite for community involvement and
commitment towards health programmes in the community.

Key Tasks Involved in Community Mobilisation

• Developing an ongoing dialogue with community members regarding

health issues

• Creating or strengthening community organisations aimed at improving health

• Assisting in creating an environment in which individuals can empower

themselves to address their own and their community’s health needs

• Promoting community members’ participation in ways that recognise diversity

and equity, particularly of those who are most affected by the health issue

• Working in partnership with community members in all phases of a project to

create locally appropriate responses to health needs

• Identifying and supporting the creative potential of communities to develop a

variety of strategies and approaches to improve health status

• Assisting in linking communities with external resources to aid them in their

efforts to improve health
• Committing enough time to work with communities or with a partner who works
with them.

STEPS IN COMMUNITY MOBILISATION

You must have at this juncture understood the concept of community Mobilisation.
Consequently, in order to mobilise communities there are steps that should be taken to gain
entry into a community. It should be noted that no one can develop a model of community
Mobilisation steps that would have rigid application in all parts of a country as large and
diverse as Nigeria. However, the following steps represent a minimum that could be
adapted for communities irrespective of whatever setting one finds oneself.
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Steps Involved in Community Mobilisation

In order to mobilise a community, the following steps are necessary:

i) Know the community

ii) Make initial contact with the community leaders
iii) Communicate intentions to the leaders
iv) Acquaint yourself with the cultural and social protocols of the community
v) Arrange meetings with the community leaders and community representatives.
vi) Develop an agenda for the meeting with the other health workers
vii) Attend the meeting
viii) Explain purpose of the meeting in an acceptable language
ix) Request them to convey the message to other community members and bring feed
back to subsequent meetings.
x) Encourage questions and participation from the audience to clarify all issues
before meeting disperses, including actions to be taken before the next meeting;
xi) Decide with participants the time, date and venue of next meeting.
xii) Have as many meetings as necessary until a consensus is arrived at.

Minkler andWallenstein, (eds.)(2003) summarized the steps for community Mobilisation

as follows:

i. Stake holder recruitment

ii. Identifying underlying conditions, as identified by community stake holders
iii. Community assessment
iv. development of a community plan (along with outcome measurements)
v. development of an evaluation
vi. plan implementation
vii. evaluate
viii. repeat!
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Graphical Representation of The Community Mobilisation Cycle

Fig.3.1 Source:Florida Department of Health,(2016)

Information to be Provided before Community Mobilisation

There are some critical questions about the community mobilisation strategy that need
to be answered (based on the results of the formative research) before proceeding with a
mobilisation effort. Planning and implementing successful community mobilisation
initiatives requires answering some important questions: These questions include:

1. What is the goal? (Described in terms that motivate citizens)

2. Who is the community? (Those most affected by and interested in the issue)
3. Where is the community now? What resources does it have? What needs or issues
are pressing?
4. Where does the community want to go? What needs and opportunities does the
community most want to pursue? When the
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Community gets where it wants to be, how will the community be measurably better?
5. What strategies and activities will move the community from where it is to where it
wants to be? What resources can be Mobilised to address these priorities?
6. How will results be assessed?
7. Who is stimulating the process? (Outside of or inside the community)
8. Who will be facilitating the process? (Community member? Community Based
Organisation (CBO) staff/volunteer? Health system worker? Local NGO staff?
International Private Voluntary Organisation (PVO) staff? Government worker outside
health system?)
9. What support structure exists for facilitators? (Training, facilitation materials,
monitoring/supervision, logistics and transport)
10. What external and internal resources are potentially available to contribute to the
effort?
11. What laws, policies, and governance structures are in place to support or limit CM
efforts?
12. To what extent do people have experience participating in community action? Who is
included? Who is left out? Why?
13. If the effort is externally supported, how long is the donor’s time frame? Is it
realistic? What is the potential for longer-term community ownership and sustainability?

With out answers to these strategic questions, community mobilisation is likely to involve
many activities, but not meet community needs or achieve important results.

Success Factors

A review of the programs that have been implemented to date suggests that the primary
ingredients of a successful community mobilisation program using maternal and new born
health as an example consist of the following:

i. program staff including: a program manager, team of facilitators (one or two selected
from a community, or more likely, a team of two to cover approximately 10 communities);
ii. trainer(s)
[Link] budget, depending on where facilitators and managers are based and may
include means of transport (e.g., bicycles or motorcycles) if facilitators need to travel
longer distances
[Link] for developing training and educational materials (e.g., training manuals, picture
cards, booklets, audio-video aids)
v. media budget (for radio shows, street drama, and other media)
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vi. training budget (depends on distance to training site, number of days, and number
of participants and existing skills/knowledge of trainees); and
vii. Other direct costs associated with office expenses.

These success factors can still be applied to other areas in health.

The Dos and Don’ts for Community Mobilisation

The Dos
i. Do it with the community help
ii. Use community expertise
iii. Understand ethnic and cultural differences of communities and build on ethnic and
cultural diversities
iv. Include others in the planning process
v. Develop community partnerships

The Don’ts
i. Do it all for the community
ii. See professionals as the experts
iii. Deny ethnic and cultural differences of a community
iv. Plan mobilization efforts alone
v. Focus solely on individual efforts
COMMUNITY PARTICIPATION
INTRODUCTION

Community participation is a proven approach to addressing health care issues and has
been very useful in HIV prevention in the United States and in development globally, in
projects ranging from sanitation to child survival, clean water, and health infrastructure.
However, the quality of participation varies from project to project. Moreover, despite the
failure of many health programs designed without the participation of target communities,
some professionals continue to question the value of community members' participating in
program design, implementation, and evaluation.

One of the fundamental Principles of Primary Health Care is the participation of the
community at all stages of development. For communities to be intelligently involved,
they need to have easy access to the right kind of information concerning their health
situation and how they themselves can help to improve some of them.
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Concept of Community Participation

Fig.4.1

Community participation differs from community mobilisation but could be interwoven

with community involvement. A WHO study (WHO, 1991) suggested that participation
can be interpreted in three ways:

• Participation as contribution,
• As organization and
• As empowerment.

When a community participates in programs by contributing labour, cash or materials, this

is contributive participation. Participation as organisation means creation of appropriate
structure which facilitates participation. Empowering participation occurs when people
develop the capability to solve their problems without waiting for help from outside.
However, in order not to make this concept cumbersome, community participation may be
used interchangeably with community involvement. Furthermore, the definition of
community participation will make the concept more explicit.

What is Community Participation?

WHO (1978) defined community participation as “the process by which individuals and
families assume responsibility for their own health and welfare and develop the capacity to
contribute to their and community’s development” By knowing (understanding) their
circumstances better, they are then motivated to solve their common problems because
they will therefore become agents (participants) of their own development. The role of the
Health Agencies therefore is to explain relevant health issues, advice and provide
necessary information and technology to find solutions to the problems.
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You will realise that this definition is quite explicit because of the components that make
community participation expedient and a necessary tool for health development in the
community.

However, there is no single definition of participation by communities but an

agglomeration of definitions varying mostly by the degree of participation. The continuum
on the next page provides a helpful framework for understanding community participation.
In this continuum, "participation" ranges from negligible or "co-opted"—in which
community members serve as token representatives with no part in making decisions—to
"collective action"—in which local people initiate action, set the agenda, and work towards
a commonly defined goal (Macqueen et al. 2001).

Community participation occurs when a community organises itself and takes

responsibility for managing its problems. Taking responsibility includes identifying the
problems, developing actions, putting them into place, and following through (Advocates
for Youth, 2001).

Beneficiaries of Community Participation Approach

Community participation has many direct beneficiaries when carried out with a high
degree of community input and responsibility. Everyone benefits when participating in the
activities. For example, adults and youth might participate in village committees to
improve services. Everyone might watch a play or video and learn from presentations
about local programs. Youth benefit from improved knowledge about contraception and
HIV/AIDS or from increased skill in negotiating condom use, and other community
members’ benefit, too. A truly participatory program involves and benefits the entire
community, including youth, young children, parents, teachers and schools, community
leaders, health care providers, local government officials, and agency administrators.
Programs also benefit because trends in many nations towards decentralization and
democratization also require increased decision making at the community level.

Major Characteristics and Skills Necessary to Facilitate a Community

Participation Approach

Promoters of community participation need to be able to facilitate a process, rather than to

direct it. Facilitators need to have trust the community's members, their knowledge and
resources. A facilitator should be willing to seek out local expertise and build on it while
bolstering knowledge and skills as needed.

According to Cheetham (2002), key characteristics and skills required to Mobilise

community participation include:

i. Commitment to community-derived solutions to community- based problems

ii. Political, cultural, and gender sensitivity
iii. Ability to apply learning and behavior change principles and theories
iv. Ability to assess, support, and build capacities in the community
v. Confidence in the community's expertise
vi. Technical knowledge of the health or other issue(s) the project will address
vii. Ability to communicate well, especially by actively listening
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[Link] to facilitate group meetings

ix. Programmatic and managerial strengths
x. Organisational development expertise
xi. Ability to advocate for and defend community-based solutions and approaches (NIH,
1995; Howard-Grabman and Snetro… ).

Major Challenges of Community Participation Programs

Community participation also poses important challenges. The two major challenges are as
follows:

i. Evaluating Participation
ii. Scaling up Participatory Models

i. Evaluating Participation
A challenge for program planners is how to evaluate community participation. For
example, what should be evaluated (health outcomes, participation levels, improved
capacities, or some combination of these) and how will they be evaluated? While
measuring health outcomes (such as birth rates or sexual health knowledge, attitudes, and
behaviors in a particular age group) may be fairly straight forward, it will be important for
community participation programs also to identify and measure indicators of participation
(Cheetham, 2002).

ii. Scaling Up Participatory Models

Funding bodies often indicate interest in programs that have potential for "scaling up."
Community participation programs present some obstacles to "scaling up" due to their
deliberately and intensely local nature. As a program develops and matures, program
planners may face the challenge of" scaling down" the intensity of community
participation in order to "scale up" the project without compromising its participatory
nature and results.

RATIONALE FOR COMMUNITY PARTICIPATION

INTRODUCTION

Since you have acquired an overview of the concept of community participation, let us
at this juncture take a look at the rationale for community participation in health care
delivery. Rationale for community participation in health care delivery simply means
the basic reasons or ideas behind community participation. The need for community
participation cannot be over emphasised. Community mobilisation will be more
sustainable than external solutions that do not fit well with the local situation, culture
and practices. When communities define the problem, set common goals and work
together on their own programs, to achieve the goals, the communities change in ways
that will last after the project ends.
Mobilisation strengthens and enhances the ability of communities to work together to
achieve goals that are important for that community.

Community mobilisation is not something that is done overnight, but it is a process that
 14

requires time and commitment from all parties involved. The key to successful
mobilisation efforts is making sure that communities are in the driver’s seat during the
process. Mobilisation is not something that happens to the community; it is something
that the community does. One of the primary goals of mobilisation is to make sure
mobilisation efforts are community driven. This allows a community to solve its
problems through its own efforts which is the key to having sustained outcomes within a
community.

In planning health programmes, the following steps are taken into consideration:
i. Need Assessments
ii. Identification of target audience
iii. Definition of the objectives and desired outcome
iv. Content and subject matter
v. Identification of training tools, activities and outpost
vi. Budget and inputs
vii. Publicity
viii. Implementation
ix. Evaluation and assessment
x. Reporting

Community mobilisation or participation is ensured before the above steps are taken. It is
required especially for the first stage which is the needs assessment.

Rationale for Community Participation

The discussions on the rationale for community participation are as follows:

I. Community participation ensures the participation of local people in identifying their

needs.
ii. The rationale includes the possibilities of the community setting their priorities,
planning and implementing health programmes in the community.
iii. Community participation helps to make the community at large aware of their health
needs and problems as well devising means to solve some of their problems.
iv. Members of the community meet with health care providers to decide jointly on
remedial actions and cooperate with health officials in carrying out health programmes and
campaigns.
iv. Community participation encourages inter-sectoral collaboration because the
community as their acceptance for the end product of all essential elements and principles
of primary health. Therefore, community participation foster multi-sectoral collaboration.
v. Community participation ensures costs sharing. Health care programmes are viewed
as accessible and affordable programmes. Consequently, funding should be shared by the
government and community members as this promotes successful implementation of the
health care programmes.

You can adduce from the facts above that community participation is important in the
achievement of health services coverage and objectives.

Even though some authors have contested that participation makes no difference, the
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usefulness of community participation has been well documented in the literature.

Involving stakeholders and empowering community participants in programs at all levels,
from local to national, provide a more effective path for solving sustainable resource
management issues (Chamala, 1995). Community participation enhances project
effectiveness through community ownership of development efforts and aids decision-
making.
The four affirmations that summarize the importance of community participation in
development as identified by Gow and Vansant (1983) include:

i. People organise best around problems they consider most important.

ii. Local people tend to make better economic decisions and judgments in the context of their
own environment and circumstances.
[Link] provision of labour, time, money and materials to a project is a necessary
condition for breaking patterns of dependency and passivity.
iv. The local control over the amount, quality and benefits of development activities helps
make the process self-sustaining (Botch way, 2001).

White (1981) identified a number of beneficial reasons for community participation in

projects as follows:

i. More work is accomplished with community participation.

ii. Services can be provided more cheaply.
[Link] participation has an intrinsic value for participants:
• It is a catalyst for further development;
• It encourages a sense of responsibility.
• It guarantees that a felt need is involved
• It ensures things are done correctly.
• It uses valuable indigenous knowledge; frees people from dependence on other peoples’
skills; and makes people more conscious of the causes of their poverty and what they can
do about it.

Policies that are sensitive to local circumstances will be more likely to be successful in their
implementation through the involvement of the local community (Curry (1993). Again,
communities that have a say in the development of policies for their locality are much
more likely to be enthusiastic about their implementation (Curry, 1993). It has been found
that participation has a role in enhancing civic consciousness and political maturity that
makes those in office accountable (Golooba- Mutebi, 2004).
Importance of Using Community Participation Approaches in Adolescent Reproductive and
Sexual Health Programming

To showcase the importance of community participation, we use adolescent reproductive and

sexual health programming as an example. Youth do not live in a vacuum, independent of
influences around them. Rather, social, cultural, and economic factors strongly influence
young people's ability to access reproductive and sexual health information and services.
To improve young people's sexual and reproductive health, therefore, programs must
address youth and their environment. In order to address youth adequately and
appropriately, programs should be designed and implemented with the meaningful
involvement of youth. To address youth's environment, planners must acknowledge that
community and families significantly influence youth(Cheetham,2002).
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Programs that ignore the influence of community and family in the lives of young people are,
in fact, creating a nearly impossible situation i.e. asking young people to change their
world on their own. It is unfair to ask youth to change their beliefs and behaviours without
also providing community support for these changes. Especially when reproductive and
sexual health issues are controversial and/or taboo, it is critical to bring other community
members into the process so that they, too, can support healthy change (Cheetham, 2002).

If implemented properly, community participation can be effective for a number of reasons

shown below:
i. Communities have different needs, problems, beliefs, practices, assets, and resources
related to sexual health. Getting the community involved in program design and
implementation helps ensure that strategies are appropriate for and acceptable to the
community and its youth.
ii. Community participation promotes shared responsibility by service providers,
community members, and youth themselves for the sexual health of adolescents in the
community.
[Link] communities "own" adolescent sexual health programs, they often Mobilise
resources that may not otherwise be available. They can work together to advocate for
better programs, services, and policies for youth.
iv. Community support can change structures and norms that pose barriers to sexual health
information and services for youth and can increase awareness regarding youth's right to
information and treatment.
v. Community participation can increase the accountability of sexual health programs and
service providers.
vi. Participation can empower youth within the community.

FORMATION AND ORGANISATION OF DEVELOPMENT

COMMITTEES

Development committees are important because prior to the establishment of primary

healthcare in Nigeria, decisions and actions relating to health were unilaterally taken by
Government Agencies on behalf of the communities Primary Healthcare (PHC)
emphasises the importance of full and active involve men to fall communities to ensure the
success of PHC in accordance with the Alma-Ata declaration of 1978. Hence, the
communities are empowered to manage in a coordinated manner, the health programmes
of their people at all times. In order to strengthen and sustain the management process, the
communities are empowered to participate and effect this management process; the bottom
up concept of planning from the village to the federal level must be applied. It’s important
to establish and sustain functional and effective development committees at all levels to
achieve health for all. This strategy emphasises on health by the people.

Description of the Various Development Committees

It is important to establish and sustain functional and effective development committees at

all levels to achieve health for all. The Development Committees at the various levels must
choose members who reside in the community, understand and speak the local language,
know and share the community’s culture, attitudes and beliefs, are respected and willing to
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contribute selflessly to community programmes.

Titles of Committees

Village Development Committee (VDC) or Community Development Committee (CDC).

a. Composition of the VDC/CDC Committee

i. A respectable person elected by the committee members as chairman

ii. An elected literate member of the village/community shall serve as secretary.
[Link] of religious groups
[Link] of women’s group/associations
v. Representative of occupational/professional groups
[Link] of Non-Governmental Organizations(NGOs)
vii. Representative of Village Health Workers (VHWs) and Traditional Birth Attendants
(TBAs)
viii. Representative of the disabled
[Link] of Youths
x. Representative of Traditional Healers
[Link] of patent medicine stores owners
xii. A trusted member of the committee will serve as the Treasurer

b. Role And Responsibilities of the Village Development Committee(VDC) or

Community Development Committee (CDC)

The committee shall:

i. Identify health and health related needs in the village/community

ii. Plan for the health and welfare of the community
[Link] available resources (human and material) within the community and allocate as
appropriate to PHC programme.
[Link] and implementation of PHC work plan
v. Monitor and evaluate the progress and impact of the implementation of health activities
[Link] and stimulate active community involvement in the implementation of developed
health plans.
vii. Determine exemptions for drug payment and deferment; but provide funds for the
exemptions/deferments.
viii. Determine the pricing of drugs to allow for financing of other PHC
Activities.
[Link] all account books, (monies at hand should be deposited in a bank within 24hours
or 72hours at weekends).
x. Supervise and monitor quantity of drug supply
[Link] appropriate persons within the community to be trained as Village Health Workers
(VHWs/TBA) for PHC, AIDS /STD and other programmes.
xii. Supervise the activities of Village Health Workers and Traditional Birth
Attendants; including review of monthly record of work;
xiii. Remunerate in cash or kind, the Village Health Workers for his/her work in the
community;
xiv. Agree with the Village Health Worker the number of hour she/she should work
 18

per day;
xv. Establish a village health post, where there is none already;
xvi. Ensure that VHW/TBA Kits are stocked to top-up level for drugs.
xvii. Liaise with other officials living in the village to provide healthcare and other
development activities;
xviii. Provide necessary support to VHW for the provision of healthcare services;
xix. Forward local community health plan to ward level.

c. Operational Guidelines

In following the above terms of reference, the committee shall:

i. Meet once every month;

ii. Record minutes of meetings;
[Link] of meetings shall be signed by the Chairman and Secretary after adoption at
subsequent meetings
[Link] with the quorum set for starting meetings;
v. The Treasurer should record and keep all monies;
[Link] Treasurer should record all expenditures;
vii. Where there is a Bank Account ,signatories will be the Committee Chairman and
Treasurer, and if necessary the Secretary;
viii. Send minutes of meetings toward Development Committee
Ward Development Committee(WDC)A:

a. Composition of the Committee Composition of the WDC is as follows:

The head shall be elected by members.

Wards head or Autonomous Clan head (Chairman), but where no such person exists, the most
respectable village head or any other person selected may serve as Committee Chairman.
In such a case, the appointment o Chairman should be left entirely in the hands of
Committee members;

i. The WDC consist of representative from each VDC in the village.

ii. The chairman shall be elected by members.
[Link] secretary of the committee
shall be elected by the members.
[Link] Wards Community Development Officer, if available

The committee can where necessary co-opt members of health related sectors such as
Secondary School Principals and Primary School Headmasters Agric-Extension Workers
PHCN/Water Works Staff, NGOs. At least 20% of membership will be women and they
should be given effective post such as Head of Health facilities in the area.

b. Roles and Responsibilities of WDC Committee The Ward Committee will:

i. Identify health and social needs and plan for them.

ii. Supervise the implementation of developed work plans.
[Link] local human and material resources to meet these needs.
 19

[Link] for health /community development plans (village, facility and Wards levels) to
LGA.
v. Mobilise and stimulate active involvement of prominent and other local people in the
planning, implementation and evaluation of projects.
[Link] active role in the supervision and monitoring of the Wards Drug Revolving Fund/B.I.
vii. Raise funds for community programmes when necessary at village,
facilities and Wards levels.
viii. Provide feedback to the rest of the community on how funds raised
are disbursed.
ix. Liaise with government and other voluntary agencies in finding solutions to health, social
and other related problems in the Wards.
x. Supervise the activities of the VHWs/TBAs, CHEWs;
xi. Monitor activities at both the health facilities and village levels;
xii. Oversee the functioning of the Health facilities in the Wards;
xiii. Provide necessary support to VHWs/TBAs;
xiv. Ensure that a Bank account is opened with is liable bank. The signatories will be
as given by the NPHCDA guidelines on the Ward Health Systems document.
xv. Monitoring equipment and inventory of monthly intervals.
xvi. Ensure the proper functioning of the Health Facility using a maintenance plan.

c. Operational Guide lines of WDC Committee The Committee shall:

i. Meet monthly;
ii. Record minutes of meetings;
[Link] that minutes of meetings be signed by the Chairman and Secretary after
approval at the next meeting;
iv. Monitor drug revolving at the Ward/Facility level;
v. Ensure that NHMIS forms are correctly filled and submitted on time;

vi. Give feed back of data collected at LGAPHC Management Development Committee
meetings;
vii. Comply with the quorum of members set for starting the meeting;
viii. Authorise the Treasurer to record and keep all monies;
ix. Authorise the Treasurer to spend money only after approval by Committee;
x. Instruct the Treasurer to record all expenditure;
xi. Chose where applicable, the ward referral centre to serve as the meeting venue and
xii. Secretariat of the Ward Development Committee;
xiii. Advise, where there is a Bank Account, signatories to be the Committee
Chairman and Treasurer and if necessary, the Secretary;
xiv. Send minutes of meetings to Local Government Area Committee. The LGA Primary
Health Care Management Committee

Each LGA should have a LGAPHC Management Committee.

The objective of this committee is to provide an overall direction for Primary Health Care in
the LGA.
 20

a. The Composition of the LGAPHC Management Committee

i. The Chairman of the LGA (Chairman)

ii. Supervisory Councilor for Health (member)
[Link] LGA Secretary;
iv. LGAPHC Coordinator (Secretary);
v. A representative of CHO Training Institutions.
vi. Principal of School of Health Technology.
vii. Representative of health-related occupational groups/associations;
viii. The Chief (or most senior) Community Health Officer in the LGA;
ix. The Community Development Officer for the LGA;
x. The Medical Officers of the secondary health facility
xi. Chairman of Ward Development Committee
xii. Ward heads
xiii. Representatives of International Organizations having PHC
programmes in the LGA;
xiv. Heads of other health-related departments in the LGA
(Education, Agriculture, Works, etc);
xv. Representatives of NGOs;
xvi. Representatives of Women/Youth Groups;
xvii. Representatives of Religious Groups;

b. Terms of Reference

The Terms of Reference of the LGA PHC Management Development Committee shall be to:

i. Provide overall direction for PHC including endemic, communicable diseases

(HIV/IDS/STD, TB, Malaria, Onchocerciasis, etc)
ii. Plan and manage PHC Services in the LGA
[Link] Man power Development for the LGA
iv. Provide the Operational Guide line for the LGA
2. Local Government Area PHC Technical Committee

There should be a PHC Technical Committee at the LGA level.

a. Composition

[Link] Coordinator–Chairman
ii. All Assistant PHC Coordinators
[Link] Managers in the LGA.
b. Roles and Responsibilities

i) Plan and budget for implementation of activities of PHC department and present same to
the LGA PHC Management Development Committee;
ii) Identify training needs for Health Workers and make proposals to the LGA PHC
Management Development Committee;
iii) Design minimum acceptable performance standard for monitoring LGA PHC
Services and develop monitoring indicators.
iv)Monitor activities of health workers;
 21

v) Design supervisory check list for LGAPHC services;

vi)Identify health related needs of communities within the Local Government Area;
vii) Plan for mobilisation of local and external resources to enhance PHC Activities;
viii) Provide feedback to committees at all levels;
ix)Monitor drug revolving fund for the health services at the LGA level;
x) Discuss PHCM’S report and take appropriate action;
xi)Give feedback of data collected at LGAPHC Management Committee meeting/facility
staff/community.
xii) Review progress of PHC in the LGA and evaluate their indicators.

c. Operational Guidelines

In carrying out the above functions, the committee shall:

i) Meet monthly;
ii) Record minutes of meetings;
iii) Adopt minutes of meetings and ensure that the Chairman and Secretary sign them;
iv)Comply with the quorum set for starting meetings.
3. The State PHC Implementation Committee
a. Composition

i. Commissioner for Health–Chairman

ii. Permanent Secretary Health
[Link] of Primary Health Care–Secretary
iv. Representatives of Health-related Ministries
v. Representatives of Women’s Associations
vi. Representatives of Extra-Ministerial Department
vii. Representatives of International Agent
viii. Local Government Areas Chairmen
ix. Representatives of Religious Groups
x. Representative of the Directorate of Local Government
xi. Chairman of LGA Service Commission
xii. Any other member as may be deemed appropriate.
xiii. Director of LGA Affairs.

b. Terms of Reference

The Committee shall:

i. Review PHC implementation plans as developed by the LGAs in the State;

ii. Provide necessary materials, technical, financial, and other support to LGAs in the
implementation of the plans;
[Link] periodic assessment surveys of the progress made in PHC Implementation
and its impact on the quality of lives of the people;
iv. Receive reports of PHC activities in the LGAs through the State PHC Coordinator and
give feedback to LGAs.
v. Liaise with other State Ministries and Federal officials operating in the State for the
enhancement of PHC services;
vi. Collaborate with NGOs and other International Agencies through the Federal Ministry
 22

of Health and National Primary Health Care Development Agency (NPHCDA) for
necessary support and assistance ;and
vii. Monitor and evaluate LGA activities at all levels in conjunction
with the NPHCDA.

3.0 The Role of Donors, Policy Makers, and External Organisations

Here, we want to use maternal and newborn health as an example to illustrate the role of
donors and policymakers in community mobilisation. The role of donors and
policymakers in community mobilisation for maternal and new born health is to ensure
that programs:
i. Integrate community mobilisation into the broader national or regional health plan.
ii. Prioritise communities with the highest mortality and that could benefit most.
[Link] implementing organisations with proven experience and expertise in community
mobilisation and maternal and newborn health.
iv. Engage communities as full partnersinp lanning, implementation, and evaluation.
v. Have sufficient financial support; have realistic timelines; are supported by policies that
promote community participation.
vi. Establish links to external assistance within the health and other sectors.
vii. Establish mechanisms to coordinate the work of all implementing agencies and
communities to ensure that perspectives at all levels are taken into account as strategies
and materials are developed, to maximise program learning and use of resources.

External assistance is most effective when it starts from where people are and facilitates a
process through which interested community members, especially the most vulnerable,
identify and implement strategies and approaches that will reduce mortality within their
local context. Additionally, external facilitators may share valuable information with
community members on effective strategies, practices, and experiences to complement
Local knowledge, making for better informed community decision-making and planning
(Howard-Graham, 2005).

To play these roles successfully, external organisations must establish relationships with
communities built on respect and trust, with faith in the ability of community members to
identify and resolve their challenges in the most appropriate way in the local cultural
setting. Ideally, community mobilisation will work together with other, complementary
program strategies (mass media, services strengthening, and policy advocacy) rather than
on its own. For example, Home Based Life Saving Skills (HBLSS) training may be offered
to interested communities that have limited access to health services; community members
may participate in the development and dissemination of educational messages and
materials; and community members may help design health facilities and health protocols
that take into account their perspectives on quality care (Howard-Graham, 2005).

In order to provide the necessary health services for a community, health care providers
must be able to identify the prevailing health issues or problems and determine their
priorities. In spite of the fact that health care facility is available, it is advisable to continue
to reassess the health situation in the community and plan services that are appropriate to
the priority health problems of the community health workers must possess the requisite
skills for diagnosing the health problems of the community.
 23

Meaning of Diagnosis

Diagnosis simply means to determine the nature of something e.g. disease .It is a statement
of the result of findings. Family Medical Compassion defined diagnosis as the process
whereby a particular disease or condition is identified after analysis and consideration of
the relevant parameter ie. symptoms, physical manifestation, results of laboratory tests etc.
Parker (1985) stated that the diagnosis of a disease in an individual patient is a
fundamental idea in medicine. It is based on signs and symptoms and the making of
inferences from them. When this is applied to a community it is known as community
diagnosis.

Definition of Community Diagnosis

Kyari (2002) defined community diagnosis as a process of finding out about the health
needs of the community. The focus of community diagnosis is on the identification of the
basic health needs of the community. FMOH (2004) defined community diagnosis as an
organised process involving identified needs, resources, wants, constraints, problems, and
disease patterns, physical, social, cultural and demographic characteristics of the
community. In community diagnosis, the entire community is regarded as a patient
requiring community diagnosis and treatment. Community diagnosis generally refers to the
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 for the
purpose of defining those at risk or those in need of health care.
The Community Diagnosis Process

The Community Diagnosis Process is a means of examining aggregate and social

statistics in addition to the knowledge of the local situation, in order to determine the
health needs of the community.

1.1 Types of Health Needs of a Community

[Link] Needs
These needs are those identified by the community itself which require solutions for
example shortage of water supply, poor roads etc.

ii. Identified Needs

These are health needs which members of the community are not aware of and are
identified during the process of community diagnosis for example pattern of disease
occurrence etc.

1.2 How Is The Community Diagnosed?

Community analysis is the process of examining data to define needs strengths, barriers,
opportunities, readiness, and resources. The product of analysis is the community
profile. To analyse assessment data is helpful to categorise the data.

This may be done in the following ways:

 24

[Link]
ii. Environmental
iii. Health resources and services
iv. Health policies
v. Socioeconomic
vi. Study of target groups.

Community is diagnosed using health indicators. Indicators of health are variables used
for the assessment of community health.

1.3 Characteristics of Indicators

[Link]: they should actually measure what they are supposed to measure.
ii. Reliability and objectivity: the answers should be the same if
measured by different people in similar circumstances.
iii. Sensitivity: they should be sensitive to changes in the situation
concerned.
iv. Specificity: they should reflect changes only in the situation
concerned.
v. Feasibility: they should have the ability to obtain data needed
vi. Relevant: they should contribute to the understanding of the
phenomenon of interest.

1.4 Classification of Health Indicators

1. Mortality indicators
2. Morbidity indicators
3. Disability rates
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilisation rates
7. Indicators of social and mental health
8. Environmental indicators
9. Socio-economic indicators
10. Health policy indicators
11. Indicators of quality of life
12. Other indicators

1. Mortality Indicators

Mortality or death rates are the traditional measures of health status. They are widely used
because there are ready available. For example, death certificate is a legal requirement in
many countries.

Mortality indicators include the following:

[Link] death rates

ii. Specific death rates: age/disease
iii. Expectation of life
 25

iv. Infant mortality rate

v. Maternal mortality rate
vi. Proportionate mortality ratio
vii. Case fatality rate
2. Morbidity Indicators

Morbidity indicators are morbidity rates or disease rates. Data on morbidity are preferable,
although often difficult to obtain.

Examples of morbidity are:

[Link] and prevalence

ii. Notification rates
iii. Attendance rates: out-patient clinics or health centers.
iv. Admission and discharge rates
v. Hospital stay duration rates

3. Disability Indicators

Disability indicators are disability rates. Examples are as follows:

[Link] of days of restricted activity

ii. Bed disability days
iii. Work/School loss days within a specified period.
iv. Expectation of life free of disability

4. Nutritional Indicators

Examples of nutritional indicators are:

[Link] measurements
ii. Height of children at school entry
iii. Prevalence of low birth weight
iv. Clinical surveys: Anaemia, Hypothyroidism, Night blindness

5. HealthCareDeliveryIndicators

Health care delivery indicators reflect the equity and provision of health care.

Examples are as follows:

[Link]/Population ratio
ii. Doctor/Nurse ratio
iii. Population/Bed ratio
iv. Population/per health center

6. Utilisation Indicators

Utilisation indicators are health care utilisation rates which show the extent of use of
 26

health services. It indicates the proportion of people in need of service who actually
receive it in a given period or year.

Examples are as follows:

[Link] of infants who are fully immunised in the 1st year of life
ii. immunisation coverage.
iii. Proportion of pregnant women who receive antenatal care(ANC).
iv. Hospital-beds occupancy rate.
 27

v. Hospital-beds turn-over ratio

7. Social/Mental Health Indicators

Indicators of social and mental health are indirect measures of health status. Often, valid
positive indicators do not often exist so in direct measures are commonly used. Examples
are as follows:

[Link] & Homicide rates

ii. Road traffic accidents
iii. Alcohol and drug abuse.

8. Environmental Indicators

Environmental health indicators reflect the quality of environment. Examples include:

[Link] of Pollution
ii. The proportion of people having access to safe water and sanitationfacilities
iii. Vectors density

9. Socio-economic Indicators

Socio-economic indicators are not direct measures of health status. They are used for the
interpretation of health care indicators. Examples are as follows:

[Link] of population increase

ii. Per capital Gross Net Profit (GNP)
iii. Level of unemployment
iv. Literacy rates-females
v. Family size
vi. Housing condition e.g. number of persons per room
vii. Age

10. Health Policy Indicators

Health Policy Indicators assesses the allocation of adequate resources. Examples are:

[Link] of GNP spent on health services.

ii. Proportion of GNP spent on health related activities.
iii. Proportion of total health resources devoted to primary health care
 28

11. Other Indicators

Other health indicators include:

i. Indicators of quality of life.

ii. Basic needs indicators.
[Link] for all indicators.

Goals of Community Diagnosis

The aims of community diagnosis are to:

i. Analyse the health status of the community

ii. Evaluate the health resources, services, and systems of care within the community
[Link] attitudes toward community health services and issues
iv. Identify priorities, establish goals, and determine courses of action to improve the health
status of the community
v. Establish an epidemiologic baseline for measuring improvement over time.

3.0 The Rationale for Community Diagnosis

The rationales for community diagnosis are as follows:

i. Community diagnosis provides realistic information specific to a community for which

definite relevant plans are made in order to solve problems.
ii. It makes the Community to be self-reliant and enables the people to have their initiatives.
[Link] diagnosis enables the people to identify their health needs and use resources in
a culturally and acceptable manner to promote their health.
iv. It helps to identify constraints which can be addressed in the planning process of any
health programme in the community.

STEPS IN COMMUNITY DIAGNOSIS

In the process of community diagnosis the following steps are necessary:

i. Make entry through the LGA into the community.

ii. Identify boundaries of the community.
[Link] a sketch map of the community using established symbols
e.g. rivers, schools, markets and other important landmarks or obtain a sketch map of the
community from the Local Government Office.
iv. Make a list of resources available in the community e.g. industries, markets, churches,
mosques, healthcare facilities and personnel, organisations e.g. transport unions, non-
government organisations.
 29

v. Make a list of cultural practices and attitudes affecting health e.g. those that are useful,
harmful and harmless.
vi. Describe social customs and important festivals of the community.
vii. Make a list of infrastructures in the community, e.g. electricity,
water supply, means of transportation etc.
viii. Collate information from the community.
ix. Conduct interviews and survey of social groups in the
community.
x. Write report using Federal Ministry of Health format.
xi. Give feed back to the LGA/State/FMOH.

1.1 Steps in Community Health Assessment Development Process

Assessment, planning models and frameworks, identifies ten steps in the community health
assessment development process (Department of health, (DOH, 2006)). They are:

i. Establish the assessment team.

ii. Identify and secure resources.
[Link] and engage community partners.
iv. Collect, analyse, and present data.
v. Set health priorities.
vi. Clarify the issue.
vii. Set goals and measure progress.
viii. Choose the strategy.
ix. Develop the community health assessment document.
x. Manage and sustain the process.

METHODS FOR COMMUNITY DIAGNOSIS

Every activity has methods of achieving its goals. There are different ways of gathering
information for community diagnosis.
These includes:

i. Observation,
ii. Interviews,
iii. Group discussion and
iv. Review of existing records.

Observation

It is very important to determine the disease that affect the community through observation
and physical examination, because some diseases are not easily recognised in the
community e.g. Anaemia, dental caries malnutrition, diabetes. In observation you observe
their surroundings, living conditions ,eating habits and life pattern to avoid wrong
impression. In observation also you are to use your eyes to see and also hear some relevant
information with your ears.
 30

Interview

The act of interviewing, involves communicating with somebody e.g. household heads,
mothers. These are people who play important role in the community in decision making
on health matters or issues. You should create a good rapport with the person so that
he/she will feel free to talk with you and give you the correct information about what you
need. The interview maybe face to face (verbally) or through questionnaire (filling a
prepared form).

Focused Group Discussion

Focused group discussion, unlike interview, is held with groups of people and not an
individual. It is useful in getting information on health needs of the community that is what
they feel as their most pressing problems.

Review of Existing Records

Useful information can be obtained by reviewing existing records particularly when trying
to determine the population of a community, the health facilities sand the health personnel
as well as disease pattern in the area. This information can be obtained from existing
records. These records maybe found in the:

i. Local Government Area office or in the health statistics department;

ii. Reports on nutritional status surveys, basically, monitoring of health status in the
communities to determine the incidence of mal nutritional diseases and proper treatment. This
survey report is important in community diagnosis;
[Link]: the map of the area is required for community diagnosis
iv. Reports by private organizations: NGOs and others could produce useful reports on
health status to assist in community diagnosis; and
v. Research records of disease pattern: The incidence and pattern of diseases in the area
can help community diagnosis. These can also be obtained from past records or research.

INFORMATION SOUGHT DURING COMMUNITY DIAGNOSIS

Geography of the Area

The major aspects that relate to this idea are mainly based on them of the area, which will
also include major settlements, seasons, type of vegetation and location in relation to
other communities.

In order to carry out community diagnosis in a Community or Local Government Area the
use of maps is necessary. Oxford Advanced Learner’s Dictionary 6th Edition defined
Map as a drawing or plan of the earth’s surface or part of it, showing countries, towns
etc.

Ibet-Iraquinma (2006) defined Map as a flat representation of a place including villages,

Towns, Local Government Area, State and Country on a paper in a diagrammatic form.
Maps enables one to obtain information about the topography of the area which include
physical features of a place for example terrain, mountains, rivers, streams, vegetation
 31

seasons etc. It also ensures the identification of target areas, shows distances to various
facilities and settlements as well as to locate population, and proximity of one settlement
to another. The Local Government Area map including that of towns and villages could
be obtained from the Chairman or the Local Government Council Area office. If such a
map is not available efforts should be made to initiate the drawing of such a map. Using
the characteristics of a map.

Epidemiological Information Needed for Community Diagnosis

Akinsola, (1993) defines Epidemiology as the study of the pattern of distribution of disease
in human populations and the factors which influence the distribution. The information
required in this context will include types of diseases and infections prevalent in the
community, their magnitude and distribution by sex, age, ethnicity, seasonal variations
and other dynamics.

Below are some of the necessary Epidemiological factors to take cognisance of:

i. Disease: Nature and patterns of occurrence of illness in the community.

ii. Occurrence: Sources of the disease and how it occurs in the community.
[Link]: Concerned with the estimation of amount of disease or the condition of
occurrence either during a given period of time or at a particular time.
iv. Distribution: The pattern produced by the disease in terms of time it occurred per
(a)person:- Male, Female (b) Place:-Temperate,
Tropical
v. Population: Group of individuals, community with common characteristics.
vi. Dynamism: Progress of the disease in the population in terms of changing pattern Over a
period of time.
vii. Determinants: Variables affecting the frequency and Dynamism of the disease in a
community e.g .age, sex and Nutritional factors.
viii. Population at Risk: Total number of community members in the population to have
likelihood (Risk) of developing the diseases or health problems.
ix. Morbidity: Degree of damage or effect caused by the disease in the population of the
community
x. Mortality: Percentage of death caused by the disease in the population in a Community.

Demographic Information Needed for Community Diagnosis

Demographic information required for community diagnosis will involve the distribution of
the population by sex, age, ethnic and religious groups as this will determine how many
people that will later require specific adequate and effective services. The basic
information about the demographic profile of the committee is as follows:

• Population Size: Total number of people in the community.

• Population Growth: Rate of increase in population of the community.
• Immigrant: Population of those people coming into the community from other country
• Emigrants: Population of those persons moving outside the community.
• Death Rate: Total number of death in a population of a community.
• Birth Rate: Total number of birth in a population of a community.
 32

• Sex: Gender quality of the community populace male or female.

• Age: Years of birth for individual community member.

Socio-Economic Conditions of the Community

These are as include occupations, income level, housing types, and living conditions,
educational level, source and nature of water supply and others. These aspects of the
Socio-economic status of the community will be explored for community diagnosis to be
carried out.

Factors that Affect Health in the Community

There are certain factors in the community that are detrimental to the health status of the
members of the community such as environmental sanitation, personal hygiene,
attitudinal and behavioral factors, customs and beliefs.

Obionu, (2001) defined environmental sanitation as the process of taming the environment
so that it does not constitute hazard to man. When the environment is not kept dirty, it
becomes hazardous to man and affect the health status of the community.

Ibet-Iragunima, (2006) defined Personal hygiene as all those personal factors which
influence the health and wellbeing of an individual. The factors include lack of
cleanliness, exercise, diet, alcoholism, smoking and others influence the health of man.
The way of life of the people (culture) and their inclination to certain things (beliefs)
also affect them even their lifestyles. The areas of food, female circumcision and
perceptions about the values of health as well as illness behavior should be given
priority attention.

CONCEPT OF SITUATION ANALYSIS

INTRODUCTION

In order to determine the ability of the health services to respond to the problems existing
in the area a careful assessment of the health situation in the community is important.
Information is collected from various sources in the Wards/Local Government Areas to
be covered. Thus, situation analysis will determine the actual status of health in a given
community.
Situation Analysis consists of a comprehensive inventory of health facilities in the LGA, their
distribution, the category of personnel and other existing infrastructure. No health program
can be adequate and effective without the personnel in the system carrying inventory of
what is on ground. Therefore, Situation Analysis is a pre-requisite for effective health
services in the any area. The idea is to tackle the problems identified during community
diagnosis.

Definitions of Situation Analysis

 33

FMOH (1996) defined Situation Analysis as the process of finding out the actual status of
health in a given community.

Ransome-Kuti, (1993) defined Situation Analysis as the process of determining the ability of
the health services to respond to the problems identified through community diagnosis.

Ibet–Iragunima, (2006) defined Situation Analysis as the ability to find out the health status
of the community and the available personnel and infrastructure to meet their needs.

The above definitions have emphasised on the health status of the community in which case
certain structure will be in existence or will be required for them to maintain good health
status.

Rationale for situation analysis simply means the fundamental reasons or ideas behind the
process of Situation Analysis. Since Situation Analysis is a necessary condition for
adequate health intervention in the communities, it must have rationale. This unit will help
you to understand as well as state the rationale for situation analysis.

The rationales for Situation Analysis are as follows:

1. To determine the effectiveness of the health services and to respond to the problems found
in the Community or Local Government Area.
2. To provide complete inventory of health facilities in the Local Government Area or
Community.
3. To identify the distribution of health facilities in the Community.
4. To identify category and number of personnel in the facilities.
5. To provide information on the type and adequacy of services provided in all the facilities.
6. To provide information on the number of settlements in each Community or Local
Government Area.
7. To identify the availability of certain basic infrastructure that affect health e.g. roads,
electricity, telephones, portable water supply, schools etc.
8. To provide a complete overview of health services, their strength and weaknesses,
health-related problems and infrastructure.

INFORMATION SOUGHT FOR SITUATION ANALYSIS

Information is a necessary tool for planning any intervention or health

actions. In order to conduct situation analysis specific information will be
required for the success of the exercise.

In the process of carrying out situation analysis, the following information is

necessary:

1. Information on LGA and Community.

2. Population by District/Wards
3. Information on LGA Health Budget
4. Health facility by type
5. Health Personnel category, number and location.
 34

6. School population and type.

7. Socio-economic status (income level, occupation)
8. Public Utilities and Services
9. LGA PHC activities
10. LGA logistic support etc.
These information are needed for situation analysis process to achieve its rationale.

STEPS IN CONDUCTING SITUATION ANALYSIS INTRODUCTION

In an attempt to conduct situation analysis certain steps are required for easy
access to the local government areas and communities.

Identification of the Steps in Conducting Situation Analysis

This process involves the following:

1. Contacting the Local Government Area Office.

2. Contacting the village development committee;
3. Obtaining the instrument to be used from the Federal Ministry of Health;
4. Training the Interviewers;
5. Practice role-playing with the instruments;
6. Arranging for snacks and transportation for the interviewers;
7. Assign individuals and provide them with materials;
8. Collating data from the field; and
9. Writing report using FMOH format.
10. Give feedback to the community and other health workers.
11. Submit report to LGA/State/FMOH

INSTRUMENTS USED IN SITUATION ANALYSIS

For situation analysis to be effectively conducted certain instruments have

been established for this purpose by the federal ministry of health.

Description of the Instruments used in Situation Analysis

There are specific instruments designed for this exercise. They include Form
H for household, Form C for children and Form F for married women
under 50years and women who have never been pregnant.
Explanation of Form H

Form H: This is called household questionnaire. These forms contain the list of all
members of the household – their demographic characteristics and also documented
illness episode for the past months.

Discussion on Form C
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Form C: It is the children questionnaire. It focuses on children, their immunization status,

their diarrhea episode and what was used for treatment or to cure them. Information
from this form gives an in-depth understanding of the health problem in each Local
Government Area and it also gives information on health knowledge and health-
seeking behaviour. The questionnaire also provides a list of illnesses that are prevalent
in the community or Local Government Area.

Explanation of Form F

Form F: This is the female questionnaire for female, married or unmarried under fifty (50)
years and women who have never been pregnant. This questionnaire probes into the
number of children each woman in the household had dead or alive. It also inquires into
what material health services the woman had during her last pregnancy.

CONCEPT OF ADVOCACY

Much needs to be done to maintain effective communication strategy for advocacy as

regards to any programme. At the policy level, there is very little awareness on the part
of some policy makers about certain programmes especially as regards their rational and
benefits.
Consequently, advocacy greetings and visits are necessary for the
achievement of some major objectives of such programmes.

Definition of Advocacy

FMOH (2005) defined Advocacy as a process of sensitizing with subsequent

follow up of policy makers and others to arouse their interest so as to get
them committed to programmes especially PHC programmes.

Olise, P. (2007) stated that advocacy is also the process of creating

awareness concerning any programme among policy makers and others in
order to solicit their support and commitment.

You will discover that in these definitions emphasis is laid on sensitization,

creating awareness and arousing interest of people so as to be involved in
health programmes. It is not one day activity but a continuous process.

INTRODUCTION

Rationale simply refers to fundamental reasons or ideas behind an activity.

Since Advocacy is a very important strategy to achieve the objectives of
any programmes especially health interventions the rationale should be
explicit for people to understand. It should however be borne in mind that
for us to discuss more on this unit you will take a look at the objectives
indicated below.

Discussion on the Rationale for Advocacy

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Advocacy is necessary for acquainting policy makers of their role and

responsibility in relation to identified health goals. This will usually
include explanations why such roles are important. When policy makers
understand their roles and underlying reasons, they will be better disposed
to provide the support and the help required from them.

In view of the facts stated above one can adduce that Advocacy is necessary
for the implementation of any health programme or any other programme.

Steps in Advocacy

In order to carry out a successful Advocacy, there is the need to follow

concrete steps to have contacts with policy makers and other groups that
are relevant in the implementation of programmes especially health
programmes. In order to follow the steps we must note the focus groups
that the Local Government, State and Federal Levels.

A. Focus Groups of Advocacy at the LGA level

1. The Chairman
2. The Secretary
3. The Supervisory Councilor for Health

4. The LGA PHC Co-ordinator (MOH)

5. The LGA PHC Committee
6. Traditional Rulers etc.

Steps in Advocacy at the Local Government level

Make initial visit to LGA/Policy Makers.
1. Discuss with the LGA functionaries, the following:
(a) Objective of the Programme;
(b) The responsibility of the LGA,NGOs, communities and individuals;
(c) Explain the National Health Policy as its relates to PHC Programme.
(d) The need for proper implementation of the programme; and
(e) Formation of management committees at various levels.

B. Focus Groups for Advocacy at the State Level

1. The State Governor

2. House of Assembly Members
3. Commissioner for Health and others.

Steps in Advocacy at State Level

Make initial visit to the governor and other policy makers and discuss intentions and
objectives of the programme as well as for them to launch the programme.

C. Focus Groups for Advocacy at the Federal Level

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1. The President
2. Members of the National Assembly
3. Chief Executives of Federal Government Agencies and
Parastatals.

Steps in Advocacy at the Federal Level

Make initial visit to the President, Ministers and members of the National Assembly as
well as other important in the system. Solicit for the launching of the programmes as
well as expatiating on the objectives of the programmes and its relationship to the
national Policy.
PROCESSES AND METHODS FOR THE DESIGN OF ADVOCACY
MESSAGES

The processes of designing Advocacy messages involve a series of things that are done
in order to achieve results of advocacy. Since advocacy is a means of seeking support to
ideas, the methods to be used should be in the mainstream of activities. It will be
necessary for individuals, groups or organisations to formulate concrete action plans to
enable advocacy yield results. This unit will help you understand the processes and
methods for the design of advocacy messages. Before we do this, let us have a view of
what you should learn in this unit, as stated in the objectives

Identification of the Processes and Methods for the Design Advocacy Messages

The most likely processes and methods to be used by individuals, groups or organisations to
design advocacy messages are as follows:

1. Invitation of key policy makers to take part in selected activities

2. Strategic alliances among like–minded initiatives
3. Joint/collaborative activities
4. Media (TV,Print, Electronic, Radio)
5. Field Visits
6. Brainstorming
7. Lecture
8. Symposium
9. Lobbying

Discussions on the Processes and Methods for the Design of Advocacy Messages

Methods for the design of advocacy message are synonymous with methods used in health
education. These methods are strategies and/or processes through which information is
presented to the target during advocacy.

1. Invitation of Key Policy–makers to take part in selected activities:

Advocacy part in selected activities: Advocacy messages should occupy the mainstream of
the activities. Many organisations do this by inviting key policy makersto take part in
selective activities such as training events and workshops, and often inviting them to open
and or close the events. Basically there is the need to prepare and use a combination of
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specific tools and approaches.

2. Strategic Alliances among Like-Minded Initiatives: In line with the overall advocacy
strategy and for results to be achieved, strategic alliances among like-minded initiatives
should be encouraged. This alliance which involves people of like-minds could form a
growing alliance especially when it involves members of the target group. This will create
a greater impact too.

3. Joint/Collaborative Activities: Joint activities with members of the target audience could
enhance Advocacy through a working process. In collaborative activities, ideas of the
advocates gradually become cleaver to all involved, ensuring deeper knowledge of the
programme by the target audience. To convince senior officials in government, NGOs, and
other relevant organisations of approaches behind any programme, there need to
participate in interesting programme activities

4. Media (TV, Print, Electronic, Radio) the use of various media, experiences and other
programmes can be shared with members of the target audience. When the main target
audience consist so factors in policy making the media will probably be printed material
and electronic media to enable policy makers understand the ideas behind the intended
programme.

5. Field Visits: This involves the target group being taken out to visit some
programmes/events that need to be carried out concerning the intended
[Link] is ideal for developing policy makers’ attitudes and decision making
on the intended programme.
6. Brainstorming: This is a critical examination of ideas, problems, situations and appraisal
of issues between the campaigners/advocates and the target audience or policy makers

7. Lecture: This involves a straight forward discussion, a pre- planned structured scheme
delivered as a topic in a session. Here, the Advocates talk to the target audience about
the intended programme including its objectives

8. Symposium: This involves presentation of papers on relevant facts about the intended
programme to the target audience in a venue. The idea is to express the full aspects of
the intended, programme for the public to buy the idea and support its implementation.

9. Lobbying: This is a process of convincing individuals or members of the public on the

need to support the intended programme. Lobbying and advocating with external
institutions, organisations and people provide a weightier support base to convince or
influence positively towards the intended programmme that needs implementation.
USE OF ADVOCACY MATERIALS

In order for effective Advocacy to take place, some materials including information,
communication and audio–visual aids are necessary. These materials are essential because,
in order for an individual to accept or adopt a new behaviour he must pass through some
stages which the materials must address.
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Identification Advocacy materials

Advocacy materials and processes include information, communication, education, audio-

visuals, flipcharts, reference books and journals. These materials help to enhance advocacy
messages in order to achieve the objectives of the intended programmes and satisfy the
desires of the advocates.

Uses of Advocacy Materials

Exposure to advocacy materials is necessary for conviction and acceptance of the intended
programme by the target audience.

Advocacy materials are useful for:

1. Creating awareness
2. Motivating people and promote desired changes in behaviour of the target audience
3. Advocacy materials educate and inform people
4. They explain the need for change
5. Advocacy materials carry information that is easily understood, remembered and retained
for future use.