Community Health Management
COMMUNITY HEALTH MANAGEMENT
Reynaldo O. Joson, M.D.
PROBLEM:
What are the general steps in managing the health problems of a community?
COMMUNITY WITH A HEALTH PROBLEM ----------------------> PHYSICIAN
GENERAL STEPS IN COMMUNITY HEALTH MANAGEMENT
1. Analysis of the health problem - DIAGNOSIS
What is the nature? (Identification of
What is the cause? the problem)
2. Strategies to solve the health problem - TREATMENT
Planning (Solution)
Implementation
3. Assessment of outcome of treatment - EVALUATION
4. Health maintenance - HEALTH MAINTENANCE
In individual health management, the physician deals with the health of individual human beings. During the actual management, the physician takes into consideration all the factors that affect the health of the individual, including the family and community factors.
Community health management is essentially similar to individual health management. In community health management, the physician still deals with the health of individual human beings, the people living in the community. Community health management is being categorized as such just to subfocus attention on the management of the health of the community as a whole and to emphasize the importance of how the conditions in the community can affect the health of the people living in it.
The first thing that a physician must do in community health management is to determine the nature of the health problem in terms of what is it and what is the cause. In medical parlance, the physician is doing a diagnosis. The diagnosis referable to a community with a health problem can also be termed as community diagnosis.
In trying to come out with a community diagnosis, the physician studies the community in terms of place, people, health sector, and whatever health statistics are available. He studies all aspects of the community that have a bearing on the health status or health problems of the community. In gathering these data, he can take an actual look at the community and he can go to the various governmental and nongovernmental agencies in the community.
The objectives of this data gathering are to determine the health status of the community and to determine the health problems of the commnity, their causes, their priority, and their possible solutions.
The data used by the physician in community diagnosis are group statistics or sampling statistics. If there is a need to verify some of the health statistics presented to him, the physician can utilize the usual diagnostic tools of interview, physical examination and laboratory examination being done on individuals.
All data gathered are analyzed by the physician to come out with a diagnosis.
The diagnosis describes the health status of the community. A community is usually said to be healthy if majority of the members of the community are healthy (based on the criteria of a healthy individual, that is, no disease; physical, mental, and social well-being; and socially and economically productive) and the community is socially and economically productive.
A community is sick or has a health problem if it is not socially and economically productive even if majority of the members of the community have no disease.
Another way of determining whether a community is healthy or not is to compare its health indices (usually, crude birth rate, crude death rate, infant mortality rate, maternal mortality rate, and life expectancy) with the standard that are considered healthy.
A more practical and easy to understand way in writing a community diagnosis is to describe all the health problems in the community and their possible causes. Usually, these health problems are multiple. In such a situation, the physician decides whether these problems will be tackled simultaneously or sequentially. In the latter decision, he must prioritize the problems in terms of importance, resource, and other bases.
For every diagnosis or health problem, there are usually more than one possible solutions. The physician must select one which he thinks is best for the community. He then implements the plan to solve the community's health problem. At this stage, he is doing treatment.
Treatment modalities for health problems of a community may include actual treatment and rehabilitation of the individual members of the community who are sick or group treatment like health education and immunization.
Oftentimes, public health programs are being utilized to solve community health problems.
After treatment, the physician must assess the outcome or the result of treatment.
There are three possible general outcomes after treatment of a community with a health problem. The community becomes healthy, meaning the health problem has been resolved. The community remains sick, meaning the health problem has not been resolved. The middle ground is that there is improvement in the health problem.
After institution of the treatment, depending on the outcome, the physician continues to solve the health problem of the community if there remains to be a problem or he maintains and promotes a healthy community if the problem has been previously resolved.
Most often, even if a problem has been solved, the physician goes on to tackle another problem. There will always be problems in the community to solve.
*What are the objectives of the physician in managing a community's health?
If the starting point in the management consists of a health problem, then the physician tries to solve it after which he tries to maintain the community's health.
If the starting point in the management consists of a healthy community, then the physician tries to maintain the healthy status of the community.
CONCEPT OF HEALTH AND DISEASE IN A COMMUNITY
Reynaldo O. Joson, M.D.
Scenarios of health and disease in members of a community:
Disease --------------------------------------------------> Death
Health ------------------------------> Disease -----------> Death
Health -------> Disease ----> Recovery -----> Disease ----> Death
Health -------> Disease ----> Disability ---> Disease ----> Death
Interactions of health and disease in a community:
Sick members ------------------------------------> Sick community
Healthy members ------------------------------> Healthy community
Healthy community ------------------------------> Healthy members
Sick community ------------------------------------> Sick members
Natural history of health and disease in a community:
Healthy community -----> Sick community ------> Healthy community
Sick community -----> Healthy community -- ------> Sick community
Criteria in categorizing community as healthy and sick:
Healthy Healthy Sick
Individual Community Community
Majority Majority
of members of members
Disease (-) (-) (+)
Physical well-being (+) (+) (-)
Mental well-being (+) (+) (-)
Social well-being (+) (+) (-)
Community Community
Socially productive (+) (+) (-)
Economically productive (+) (+) (-)
Disease
- Any condition that can kill an individual or person.
- Any condition that can cripple an individual so as to prevent him from being socially and economically productive.
- Any condition that can hurt an individual so as to prevent him from being socially and economically productive.
General causes of health problems in a community:
Degree of Preventability
Genetic causes (-) to (+)
Environmental causes (+)
Self-induced causes (+)
Factors that promote diseases in the community:
Genetic factors
Environmental factors
Self-induced factors
The health practices and beliefs of the community as a whole that have a bearing on disease prevention and promotion.
Hygienic practices
Drugs
Alcohol
Smoking
Diet
Exercises
Relaxation
Factors that promote health in the community:
Control of environmental factors that promote disease.
Control of self-induced factors that promote disease.
MUNICIPAL HEALTH OFFICER
FUNCTIONS AND ACTIVITIES
1. Attends to the administration of the rural health service.
a. Assesses community health status.
b. Plans and implements health programs and instructions in accordance with guidelines set by the Department of Health and under the supervision of the Provincial Health Officer.
c. Develops the capabilities of his staff on a continuous basis through formal teaching, staff meetings, regular participation in their activities, etc.
d. Supervises all aspects of the health work, keeping in mind that supervision should take the form of problem identification, problem solving, guidance, training, support, and encouragement.
e. Keeps liaison, through meetings and other possible avenues, with the private health sectors, other public agencies, municipal and barrio authorities, and members of the other sectors of the community.
f. Sees to it that supplies and equipment needed by the unit promptly requisitioned, well maintained, kept, and accounted for.
g. Ensures that all required records and reports are properly accomplished and submitted promptly.
h. Whenever so directed by the Provincial Health Officer, attends conferences of Municipal Health Officers or such other conferences at which his presence may be needed for the good of the service.
2. Provides epidemiological and environmental health services to the community.
a. Studies weekly incidence of notifiable diseases; conducts epidemiological investigations when indicated; and institutes proper control measures in association with his staff.
b. Cooperates with other health officers in the suppression of any epidemic.
c. Exercises general supervision over the hygienic and sanitary conditions of the municipality, including public and private premises therein. In this connection, he shall:
- enforce all sanitary laws and regulations applicable to his municipality and shall cause all violations of the same to be duly prosecuted.
- abate any nuisance endangering public health.
- remove the cause of any special diseases or mortality.
- enforce any internal quarantine regulations applicable to his municipality.
- draft and recommend to the municipal council of his municipality suitable ordinances or regulations for carrying into effects the powers conferred by law upon such body in respect to matters of sanitation.
- determine the cause of death of persons dying without medical attendance and issue the necessary death certificate.
- promote the registration of vital events.
3. Serves as the clinician of the unit.
a. Holds regular clinics for referred cases (morbid, MCH, Family Planning, nutritional) in the main health center and provides free medicine when indicated and available in the unit.
b. When called, attends personally to all cases of difficult labor and serious illness.
c. Refers cases needing further care to the nearest hospital. In the case of indigent patients, provides assistance in their transportation.
d. Conducts the required physical examination of government employees, applicants for permits/licences/tests and persons in custody, school children, and of others entitled to such services.
4. Acts as the medico-legal officer of the community.
a. Attends to medico-legal cases, but issues the corresponding certificate only to either the chief of police, fiscal or judge. In the case of autopsies, performs the same only upon request of any of the
aforementioned officials.
5. Ensures the continuing education of the public in matters of health.
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