COMMUNITY DIAGNOSIS

According to WHO definition, it is a quantitative and qualitative description of the health of

citizens and the factors which influence their health. It identifies problems, proposes areas for
improvement and stimulates action.
What is its purpose!
". Anal#ze the health status of the communit#.
$. %valuate the health resources, services, and s#stems of care within the communit#.
&. Assess attitudes toward communit# health services and issues.
'. Identif# priorities, establish goals, and determine courses of action to improve the health
status of the communit#.
(. %stablish an epidemiologic baseline for measuring improvement over time.
The Management Process
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Chapter 1
BACKGROUND AND SETTING OF THE COMMUNITY
A. Historical Background
B. Physical Description of the Area
)eographic *haracteristics
+opograph#
,oil *lassification
Agriculture
*limate
-ap
2
Chapter II
POPULATION ANALYSIS
A. Population Size and Distribution
B. Age and Sex Distribution
Age .ependenc# /atio
C. Family Size
3
Chapter III
ANALYSIS OF RELATED SOCIO ECONOMIC CONDITION

A. ECONOMIC INDICES
Agricultural products
*rops
0ivestoc1
2arm Implements
Monthly Family Income
Occupation
Dwelling-related Indicators
Housing ,tatus
0and ,tatus
House /oofing
House 2looring
House *onditions
Household appliances
Ownership of vehicles
B. SOCIAL INDICES
Marital status
Ethnic Origin
Religion
Education
Existing school and teacher pupil ratio
4
Communication
Transport
Welfare services
Recreational services
C. ENVIRONMENTAL INDICES
Electricity
Source of water
Sanitation
Toilets
Waste disposal
D. POLITICAL STRUCTURE
Local government administration and political subdivision
Peace and Order situation
E. CULTURAL FEATURES
Community celebrations
Customary practices
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Chapter IV
ANALYSIS OF THE HEALTH SECTOR
A. HEALTH SERVICES
B. HEALTH HUMAN RESOURCES
Ratio of health human resources to population
C. HEALTH INDICATORS
Prenatal Care
Family Planning
Reproductive Intention
Childbirth and Delivery
Post-natal Check-up
Breastfeeding
Nutrition
Expanded Program on Immunization
Deworming
Vitamin A Supplement
Health programs and classes
Morbidity
Mortality
Note: there should be discussion on this comparing with national, regional, city, other
barangays
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Chapter V
THE PROBLEM
Problem Identification
Identif# 3at most4 "5 problems with #our communit#
Determine Priority
Priority determination is a method of imposing peoples values and judgments of what is
important onto the raw data.
*riteria in the /an1ing of a 6roblem
7ulnerability to Change
8 e9istence of effective technolog#
8 feasibilit# of implementing the technolog#
8 financial, human resources and organization
P !vailability of technology gets higher score.
Magnitude of the Problem
8 -an# are affected, higher complications
P "f more are affected, the higher the score.
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Sitio Acasia, Barangay Tamugan, Marilog District
1. Low family income
2. Increase incidence of acute respiratory infection and
acute gastroenteritis
3. Improper waste disposal
4. Lack of postnatal visits
5. Increase ome deliveries
6. !ig incidence of ealt risk factors "e.#. $moking%
alcool drinking&
7. 'alnutrition
(. Low educational attainment
). !ouseolds witout toilets
1*. +o electricity
Social Concern
8 the value attached b# the communit# to the problem
8 the problem affects certain age, se9 or marginalized
P "f e#pressed by the community as important, the higher the score.
Existing Health Policies
8 the intervention:s on a particular health condition is anchored on e9isting health policies
Problem
Magnitu
de of
the
Problem
Vulnerabil
ity to
Change
Existing
Health
Policies
Social
Concer
n
Total Rank
Low ,amily Income 5 2 5 7 1) 5
Increase Incidence of
-.I/-#0
) 6 4 ) 2( 2
Improper 1aste 2isposal 3 ) 2 2 16 6
Increase !ome 2eliveries 7 3 ( 4 22 4
Lack of 3ostnatal 4isits 6 1* ) 2 2( 2
!ig Incidence of .isk
,actors
2 ( 3 6 1) 5
'alnutrition ( 5 1* ( 31 1
Low 0ducational
-ttainment
4 1 6 1 12 7
!ouseolds witout
5oilets
1* 7 7 1* 27 3
+o 0lectricity 1 4 1 5 11 (
(
Problem Tree Analysis
Anal#ze the problem and determine the cause8effect relationships between the
problems;
7isualize the cause8effect relationships in a diagram; and
Identif# the central or core problem
)
Analysis of Causes
Can Be cted by the Health
Sector
Can Be cted by !ther Sectors
Lack of 6nowledge +o Latrines
3oor 3ractice 2egraded $oil
3oor !ygiene ,ailed !arvest
2iarrea
3oor 2iet
"mmediate Concern Medium to #ong$term Solution %
&eeds #egislation
Lack of 6nowledge 3oor 2iet
3oor 3ractices 2iarrea
3oor !ygiene
Objective Tree
8 is a visual representation of ob<ectives
8 is the positive opposite of the problem tree
1*
Chapter VI
HEALTH ACTION PLAN
Title:
Problem:
Rationale:
General Objective:
A program goal 3general ob<ective4 is
a broad and future8oriented statement on the
8 overall purpose
8 intent
8 e9pected outcome
of a program to meet a defined problem.
the $%!& of the process
8 =what> will the program:pro<ect accomplish
%9amples
' &o reduce the incidence of cardiovascular disease among ()*+ employees.
' !ll cases of dengue in (avao ,ity will be eliminated.
' &o stop the spread of %"- in the youth of (avao ,ity.
Specific Objectives:
6rogram Ob<ectives
are more specific and describe in a measurable wa# the desired end result of program
activities
statements that support the goal
the HOW of the process
%lements of a well8written ob<ective
". +he outcome to be achieved or what will change.
$. +he conditions under which the outcome will be observed, or when the change will occur.
&. +he criterion for deciding whether the outcome has been achieved, or how much change.
'. +he target population, or who will change.
%9amples
' .y the end of the November /011, all the mothers of the malnourished children will have
improved 2nowledge on proper nutrition and hygiene.
' !ll the mothers of the malnourished children will have improved 2nowledge on proper
nutrition and hygiene by the end of November /011.
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12
TITLE: Tamang &utrisyon Tungo sa 'alusugan(
PROBLEM: T)enty$four *of +,- children .,$/, months old are
belo) normal$lo) )eight *for age-0 )hile , are belo) normal$
1ery lo) )eight2
RATIONALE: &utrition is a basic human right0 1ital for sur1i1al0
gro)th and de1elo3ment2 Malnutrition is caused by a host of
interrelated factors2
4hile re3orts indicate that there is enough food to feed the
country0 many 5ili3inos continue to go hungry because of the
lack of kno)ledge and 3oor 3ractices2
GENERAL OBJETI!E:
ll the malnourished children in Purok casia )ill be )ell$
nourished2
SPEI"I OBJETI!ES:
.2 By the end of &o1ember ..0 ,6..0 all the mothers of
malnourished children )ill ha1e ade7uate kno)ledge on
nutrition2
Causes of
the Core
Problem
!b8ecti1e cti1ities Materials
&eeded
Time 5rame Persons
Res3onsible
!b8ecti1ely
Veri9able
"ndicator
3oor
knowledge
7y te end of
+ovem8er 11%
2*11% all te
moters of
malnourised
cildren will
ave
ade9uate
knowledge on
nutrition.
Lecture on
+utrition
4enue
4isual aids
$nacks
+ovem8er 2( 'edical
:lerks
7!1s
Lecture
conducted
-ttendance
3re;/3ost;test
3oor practices 7y te end of
+ovem8er
2*11% all te
moters will
practice good
nutrition tru
8ackyard
gardening
and preparing
and cooking
nutritious
meals.
2emonstrat
ion on
7ackyard
gardening
4enue
4isual aids
+ovem8er 2) 'edical
:lerks
7!1s
7+$
$anitary
Inspector
.ep from
-griculture
Lecture
conducted
-ttendance
.eturn demo
7ackyard
garden
3oor ygiene 7y te end of
+ovem8er
2*11% all
malnourised
Lecture
2emo
4enue
4isual aids
+ovem8er 3* 'edical
:lerks
7!1s
Lecture
conducted
-ttendance
.eturn demo
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For the exit conference and fnal
report, include the number of
attendees, pre- and post test
scores (mean), and other
indicators!
cildren will
practice good
ygiene.
Activities
measurable amount of wor1 performed to convert inputs into outputs
describes how 3means3 the ob<ectives will be accomplish an action to ta1e to accomplish the ob<ectives
,omponents
What steps or actions must be performed, in what order, to achieve the ob<ectives!
Who is responsible for the implementation of each activit#!
When is the activit# to ta1e place, including desired time frames for beginning and completing each activit#!
Where is each activit# to ta1e place!
Program Implementation
is putting the plan to wor1 on the field
Monitoring
is an ongoing collection and anal#sis of information to both assess the progress of implementation and determine whether results are
being achieved
Evaluation
is the s#stematic collection and anal#sis of data ? to assess the strengths and wea1nesses of programs ?to improve their effectiveness.
3American %valuation Association4
14
'onitoring< 5racking progress towards
o8=ectives.
Have we done what we said we would do?
0valuation< 3utting a value on te work.
Have our e!orts been worthwhile?
ECONOMIC EVALUATION OF PROGRAMS, INTERVENTIONS AND INVESTMENTS IN THE HEALTH SECTOR
Evaluation of Programs and Interventions
One of the most important ob<ectives of economics is to ma1e sure that we ma9imize the output, out of the inputs that we process to
produce goods and services.
15
-@% compares the before and after.
-@% compares the with and without situations.
%*OAO-I* %7A0BA+IOA refers to the s#stematic anal#sis attempt to identif# measure, evaluate and compare the cost 3inputs4
and benefits 3outcomes4 of two or more alternative treatments or interventions. 8 4abay, et. al
Measuring Costs and Outcomes
+o assess whether the health resources are used optimall#, there must be a wa# to measure the costs of health interventions 3e9penses in
tr#ing to produce better health4, and the effects of these health interventions 3the health effects of the costs spent4 or its abilit# to produce
better health4.
Ideall#, the effects of health programs, activities, or interventions, should outweigh their costs.
2ig. &. Ideall#, outputs or outcomes of health intervention 3health effects4 should outweigh the costs of such intervention. +o be able to
assess, we sould 8e a8le to measure te costs involved in an intervention% and compare tem wit te e>ects of suc.
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Basic Principles of Economic Evaluation
". .ecision -a1ing
8 economic evaluations are techniques done to evaluate options which all promise to produce better health
8 allows program planners to have an ob<ective basis for choosing a specific option from a list of several
$hich of the alternatives will provide the most health effect for every peso spent for the improvement of health5
$. *omparing *osts with Cenefits
8 costs attached to the available options are measured against the health effects or benefits that the# produce
&. Cang and Cuc1
8 bu#ing and pla#ing with firecrac1ers
8 economic evaluation techniques are essentiall# comparing buc1s and bangs
%ow much bang do you get for each buc2 spent for5
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2ig. '. ,ample %conomic %valuation 6rocess
Types of Economic Evaluation
1. Cost-Effectiveness Analysis
*%A
compares effects and costs
TOTAL COST / TOTAL HEALTH EFFECT
1(
more specificall#, it evaluates
8 which possible intervention will best achieve a given ob<ective at the least cost
8 when given a fi9ed budget, which intervention ma9imizes the
effectiveness of the e9penditure
it is a ratio that compares costs per health effect
costs and outcomes are measured in non8comparable units
generall# used to eitherD
8 compare alternative programs with a common health outcome,
or
8 assess the consequences of e9panding an e9isting program
+able ". %valuating Options in Bnderta1ing an Immunization .rive
Options Number of Children
Immunized
Total Cost of the
Project
Cost-Effectiveness
Ratio
Bse Caranga# Health
*enters
&(,555 6&,(55,55 6EF.(E:child
immunized
Bse mobile clinics '(,555 6(,G(5,555 6"$G.GG:child
immunized
1)
Bse Hollibee stores &F,IG5 6&,G(5,55 6EI.EG:child
immunized
2. Cost-Minimization Analysis
*-A
a derivation of *%A
focuses on the costs of different alternative programs or intervention options
assumes that regardless of whichever option is ta1en, the effects or the outcomes will be identical
with the assumption that the outcomes of the interventions are measurabl#
identical, the least cost option is chosen
the simplest form of economic evaluation
advantages
8 the measurement problem is reduced in e9amining resource
consequence
8 anal#sis will consist of simpl# comparing costs alone, or considering
other resource consequences that are measured in monetar# terms in
order to identif# the least cost alternative or the cheapest option
disadvantages
8 inappropriate to use if $ treatments signal differences in effectiveness, or the cheaper option ma# harm the patient
8 needs a strong assumption that individual health effects are the same between $ alternative treatments
another e9ample, is blood pressure monitoring
2*
3. Cost-Utility Analysis
*BA
special form of the *%A
estimates the ratio between the cost of a health8related intervention and the benefit it produces 3outcome4
outcomes are measured in terms of utilit# 3well8being4; in terms of the number of #ears lived in full health b# the beneficiaries
the most well81nown measure of health utilit# is the Jualit# Ad<usted 0ife Kear 3JA0K4
8 measures qualit# of life from 5 to " 3where O denotes death and " equates to perfect health4
8 is the product of qualit# of life and length of life
COST / QALY Gained
for e9ample,
8 intervention A allows a patient to live for & additional #ears than if no intervention had ta1en place, but onl# with a qualit# of life
weight of 5.I,
8 then the intervention confers 3&435.I4 L ".F JA0Ks to the patient
8 if intervention C confers $ e9tra #ears of life at a qualit# of life weight of 5.G(,
8 then it confers ".( JA0Ks to the patient M3$435.G(4N
8 the net benefit of intervention A over intervention C is therefore, ".F 8 ".( L 5.& JA0Ks
in the BO, as of Hanuar# $55(, the Aational Institute for Health and *linical %9cellence 3AI*%4 is believed to have a threshold of
about P&5,555 per JA0K
in Aorth America, B,Q(5,555 per JA0K is often suggested as a threshold I*%/ for a cost8effective intervention
35.& JA0K43B,Q(5,5554 L B,Q"(,555
21
8 3".F JA0K43B,Q(5,5554 L 3B,QE5,5554
8 3".( JA0K43B,Q(5,5554 L 3B,QG(,5554
Table 2. CUA for Treatment of Breast Cancer
Without Cobalt Treatment With Cobalt Treatment
%stimated survival L & #ears %stimated survival L "5 #ears
%stimated JA0K weight L 5.( %stimated JA0K L 5.F
JA0Ks L 3& 9 5.(4 L ".( JA0Ks L 3"5 9 5.F4 L F
JA0K gained from cobalt treatment L F R ".( L I.( JA0Ks
*BA L 3I.(43B,Q(5,5554 L B,Q&$(,555
4. Cost-Benefit Analysis
*CA
values both costs and benefits in mone# terms and compares them
directl# compares the benefits of a chosen option against the costs incurred with the option
evaluation criterion becomes a ratio
the ratio shows how man# times the cost is earned b# its effect through the monetar# benefits of a certain option
8 a ratio of one 3"4 means that the option simpl# had the same monetar# benefits compared to the costs attached to the option
to ma1e a decision, if the program ratio is greater than one 3"4, the pro<ect is worthwhile
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as the ratio becomes higher than one 3"4, the pro<ect becomes more worthwhile
%9ample
S Assume that we are evaluating a pro<ect proposing to vaccinate $,555 children for measles in a certain distant baranga#.
S Assume also that the cost per child immunized is 6&55.55. If we do not immunize these children for measles, there is good
chance that the# will contract it. Is it cost8beneficial to immunize all of these children!
S Assume further that all these parameters are trueD
T E5U of immunized children will contract measles
T of those who will contract it, &5U will have complications
T of those who develop complications, &5U will have meningo8encephalitis and G5U will have bronchopneumonia
T costs are as followsD
8 uncomplicated cases L 6 (55:case
8 meningo8encephalitis L 6$5,555:case
8 bronchopneumonia L 6"(,555:case
S cost of immunizing $,555 children at 6&55.55 each L 6I55,555.55
S cost of not immunizing children
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Cases Cost Total
",$I5 uncomplicated cases 9 6 (55.55 6 I&5,555.55
"I$ meningo8encephalitis 9 6$5,555.55 6&,$'5,555.55
&GF bronchopneumonia 9 6"(,555.55 6(,IG5,555.55
+otal 6E.('5,555.55
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