(Member of the health community health team) Anggota dari tim kesehatan masyarakat Would it not be wonderful if the

community health team were a well-defined entity? The fantasy comes to mind of a group of people, perhaps dressed in very official-looking blazer with emblems on the pockets, meeting each morning in an office with a coach handling out assigned duties, giving a short pep talk, and then the team memberss dispersing to stamp out proverty, illness , and miscry in their town specialized and highly effective ways. What a pity real life is not like this. There are few instances in which the community health team actually functions as a cohesive unit with all members under the direction of and responsible to the same person. In associating community health concepts with the word team, perhaps the dictionary definiton (a number of persons associated in same joint action, especially one of the sides in a game or contes) should not be iken too literally. Theoretically all those who are enganged in a joint action to improve and maintain that health, but in reality there is often so much political squabbling, duplication of services, power struggling, buck passing, and ego tripping that it is a wonder that anything at all accomplished. If one stands back far enough from the everyday machinery of the organizations involve in community health work, one can see a grand scheme: one can see the theoretical concepts being put into practice, and one can see the development of new concepts and ideas. It is just that we are so busy with the day-to-day activities of our jobs (and frequently complaining about other people not doing theirs!) that we dont take the time to stand back and look at what is happening. If the team approach to community health is to work, there must be same basic factor operating. First, there must be a common goal, although it is understood that each group of health workers will have its own subgoals. The goal of the communityhealth team should be the achievement of optimum health for all members of the community, and for method to achieve that goal, the reader is referred to Chapter 3 on ageinces. Second, the presence of professional people who have the skills necessary be a process of communication to plan and to evaluate goals. These three necessary ingredients have separate functions. But theye are al interdependent. And none can exist without the other two. The professional health workers pla, implement, and evaluate the goals; without their skills there would be no way achieve them. The communication process is the means by which the goals are formulated in the firs place; without the process there would be no way to determine whether or not the plants had been implemented. Discussion of the community health team is very

provide for the needs of its membership. Horizontal patterns of communication greatly influence the internal dynamics of the community. This communication within the community culture, tradition, values, and attitudes from generation to generation and helps to preserve to community. Community Leadership The leadership and decision making processes within a community critically influence how well that community will function. A community usually has official (elected and appointed) leadership is obvious to community members and other communities. However, much of a communitys leadership is nonofficial (not elected or appointed). Nonofficial community leadership is less obvious and may be more difficult to detect. However, this leadership often has more influence, power, and control over commnity action and decision making than the official leadership. The local community religious leader to whom people may go for advice and guidance, and the wealthy philanthropist who heavily subsidizes community health activities, are examples of non official leaders. Nonoficial leaders are often tha heroes of the community, those whom people in the community revere and respect. It is frequently such people in the commuty to whom other turn for advice, emmotional support, and assitance. The use of these non official leaders in health education activities can aid in the adoption of health promotion behaviors (Wiost, Flack, 1990,p,381) The community health nurse will find it useful to identity community leaders greatly influence what type of service will be available for the community. They can assist in making health a community priority and facilitate the implementation of health care service in the community. An example of such facilitation ia a research study by Wiist and Flack (1990) that showed how to support of religious leader in a community made a large-scale cholesterol education program possible and succesful. Some aspect of community life are controlled by leadership decision made outside the community. These decision are frequently in the form state, federal, and international law and regulations. The community must adhere to such legal decision even though they may be conflict with its values, attitudes, and ideology. Such health and welfare legislation is disscused throughout this text.

Community Functions To provide for the lifeb goals and needs of its population, the community carries out of number functions. Warren (1978,pp.171-212) gives the following functions of a community: PRODUCTION-DISTRIBUTION-CONSUMPTION The community produces, distributes, and uses goods and servicer that are essential for meting the health and welfare needs of its residents. This triad of activitiesinvolves extensive resource and service coordination. SOCIALIZATION Socialization is the process by which prevailing knowledge, values, beliefs, customs, and behavior are transmitteed to community members. It is a lifelong process that helps person learn how to effectively relate in asocial enviroment and to develop a philosophy of life. SOCIAL CONTROL The community influences the behavior of itsmemebers through norms, regulation, and rules of social control. Social control has a legal componenet that is often enforced

through law agencies, court, and the goverment. It also has a social sanction component. Social control helps to safeguarg and protect the community by providing mechanisms for safety and order. SOCIAL PARTICIPATION People have basic needs for self expression and self-fulfillment. These needs are largely metthrough interaction with other. This function provides opportunity for members of the community to communicate, socially interact, and obtain support. It helps community member to achive psychosocial wellnes. Social networks evolve through social participation MUTUAL SUPPORT Mutual support involves people lending assistance to one another. It is frequently offered through family, friends, neighbors, and religious groups, ass well as official and private health and social service organization within the community. These function provide for the services and activities necessary for everyday community life. The way in which a community carriers out these function affects how well the community health nurse will be able to meet the needs of the population.

The Functional Community The figure on community dynamivs illustrated how components of the community interact to create a functional, healthy community. Functional communities can identify, prioritize, and address community strengths and needs and are capable of problem solving and crisis resoution. Functional communities collaboratively work with health care professionals to increase and maintain communitycompetence According to Warren(1988 pp.413-418) a functional community has the following characteristics: people interact, participate, and have a degree of commitment to the community; the community has some autonomy from the larger society; people can confront their problems through concerted action (viabilty); decision making is relatively equally distributed throughout the population and not concentrated (power distribution); there is a balance of differences (degree of heterogeneity); and the degree of conflict is manageable. THE HEALTH SYSTEM AND THE COMMUNITY As mentioned previously in this chapter,community service system help a community to achieve its basic needs. The community service system of health is of major impotence to the community nurse. Health system resources include individuals and groups, private health practitioners, community health volunteers, hospitals, clinics, pharmacies, nursing homes, health departements, and departements of social services. The priority that the community places on health, and the resources it funds and allocates, will play a major role in the overall health of the community. Difficulties in the Community Health System When analyzing the community health system, several concerns may become apparent. A major concern stressed in Health People 200 is that access to appropriate health care services for reasons suchas cost, transportation, and lack of an appropriate resource. Some people simply fall through the cracks in our health care. The working poor in our communities often have problems of access to health care as a result of being uninsured of underinsured.