The Process of Conducting a

Community Entry / Diagnosis

in Rural Nigerian
Communities
Subgroup 5, Group B 2017 Set
 Joy Babayemi

Peter Aremu
Group
Members Onome Mokuro

Saheed Jimoh
 Introduction

Community Entry
Outline
Community Diagnosis

Methods of Community Diagnosis

Introduction
  Community diagnosis as a quantitative and
qualitative description of health of citizens and
Community the factors which influence their health.
Diagnosis
 It simply identifies problems, proposes areas
for improvement and stimulates action.
  Community Engagement is the process of working
collaboratively with and through groups of people
In a community to address issues affecting the well-
Community being of those people. (Simpson et al., 2019)

Entry  It comprises of 3 main steps:

✓community entry
✓community mobilization
✓community empowerment
  Community entry is defined as the process of initiating,
nurturing and sustaining a desirable relationship with the
Community purpose of securing and sustaining the community’s
Entry interest in all aspect of a programme. (Vermeulen et al.,
2015)
  A community is 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 settings.(MacQueen et al. 2001)
Community
 Types
✓Rural community
✓Sub-urban community
✓Urban Community
 Rural Community Urban Community

Types of
Community
 Village Head

Village Council (Chiefs)

Leadership President/Chairman (Community

Development Committee)
Structure
Influential leaders

Members of the community

(the people)
  Formal Leaders
✓e.g Obas, Emirs, Ezes

Leaders in a  Informal Leaders

✓Women leaders, market women leaders, youth leaders
Community
 Opinion Leaders
✓Counsilors, pastors, imams
Community Entry
  Community entry is defined as the process of initiating,
nurturing and sustaining a desirable relationship with the
purpose of securing and sustaining the community’s
Community interest in all aspect of a programme. (Vermeulen et al., 2015)
Entry
 Community entry is a prelude to any action that will
take place in a true partnership with the community. .
(Ullah et al., 1997)
  Entails entering community spaces intending to meet people
where community members are most comfortable. 7

 Staff leave their work places and go into the community to seek
Community out and speak with members who live there.
Entry
 It also recognizes the community, its leadership and people and
adopting the most appropriate process in meeting, interacting and
working with them.
 1. Establishing dialogues with the community members

2. Identifying community problems

Steps in
Community 3. Discussing intersectoral issues

Entry 4. Mobilizing the community to take action

5. Establishing partnerships within the community.

 Establishing dialogues with the
community members

✓This involves activity on the part of the participatory worker who

first establishes a dialogue and talks to the community on the
Step 1 issue of participation.
✓The contents of the talk are seldom remembered.

✓During this stage, the participatory worker develops some

knowledge of people and their circumstances, albeit only
superficial.
 Identifying community problems

✓Understanding grows to the extent that people bring in

intersectoral issues and begin to address them.

✓Before doing this, the participatory worker has to seek the

collaboration of people from the different sectors.
Step 2
✓Therefore, rallying the allied departments for this move towards
community involvement in public sector activities become
important.
✓It might be that these are the issues which are felt needs, and
entry into the community may be possible only by addressing
them.
 Discussing intersectoral issues

✓Understanding grows to the extent that people bring in

intersectoral issues and begin to address them.

✓Before doing this, the participatory worker has to seek the

Step 3 collaboration of people from the different sectors.

✓Therefore, rallying the allied departments for this move towards

community involvement in public sector activities become
important.

✓It might be that these are the issues which are felt needs, and
entry into the community may be possible only by addressing
them.
 Mobilizing the community to take action

✓Though people involved in step III intend to address problems, their

attempts are still superficial – sometimes lacking understanding and
not always dealing with the root cause of their problems.

✓The participatory worker, at this stage, should be working with people

Step 4 to analyze all these related problems and identify their root cause.

✓This is the time to direct people’s attention towards some action.

However, extreme care should be taken that these efforts are
consolidated and not misdirected.

✓This is extremely difficult and it often hinges on people’s vested

interests; it requires an appropriate strategy and action planning.
 Establishing partnerships within the
community

✓This is the peak in the community involvement process and detailed

work is done at this stage.

✓Provided the participatory worker has worked to properly mobilize

Step 5 the people, they identify their role in the future plan of action
designed to address problems facing them.

✓Further, being the one charged with the responsibility to provide

services, the public sector should then take the lead.

✓ This will essentially stimulate people and be a reason to actively

contribute – another step on the plateau of community entry and an
ultimate objective of the community participation process
Advantages of  The establishment of good working relationship
Community  Objectives are achieved
Entry  Recognition and observation of protocols
 Attitude
✓Patience
Attitude and ✓Good listening attitude
Skills required ✓Respect for other people
for Community ✓Tolerance
✓Humility
Entry
✓Non-judgmental with positive attitude
 Skills
✓Maintain good eye contact
Attitude and ✓Good listening skills
Skills required ✓Excellent communication and interpersonal
for Community skills
✓Be empathic
Entry
✓Paraphrase
✓Encourage others to listen
Community Diagnosis
  Community Diagnosis is the detailed assessment of the health
status and strength of a community as a whole in relation to its
social, physical and biological environment.

 The World Health Organisation (WHO) defines community

Community diagnosis as a quantitative and qualitative description of health of
citizens and the factors which influence their health. It simply
Diagnosis identifies problems, proposes areas for improvement and
stimulates action.

 It is regarded as the foundation for improving and promoting the

health of community members.
  Analyze the health status of the community.
Purpose of  Evaluate the health resources, services, and system of care within the
Community community.
 To assess attitudes toward community health services and issues.
Diagnosis in
 Identify priorities, establish goals, and determine courses of action to
Community improve the health status of the community.
Health  Establish an epidemiologic baseline for measuring improvement over
time.
 Comprehensive Community Diagnosis
 It focuses on obtaining general information about the community,
Types of the strengths and weaknesses of the community as a whole-
everything. Prioritizing health problems come later on in the
Community process.

Diagnosis Problem-oriented Community Diagnosis

 It deals with problem that are readily seen and should be acted
upon immediately e.g. in the case of an epidemic.
  Multisector collaborations that support shared ownership of
all phases of community health improvement, including
assessment, planning, investment, implementation and
Principles evaluation.
guiding  Proactive, broad, and diverse community engagement to
improve results.
Community  A hospital’s definition of a community that encompasses
Diagnosis both a significant enough area to allow for population-wide
interventions and measurable results, and includes a
targeted focus to address disparities among sub-
populations.
  Maximum transparency to improve community
Principles engagement and accountability.

guiding  Use of evidence based interventions and encouragement of

innovative practices with thorough evaluation.
Community  Evaluation to inform a continuous improvement process
Diagnosis  Use of the highest quality data pooled from, and shared
among, diverse public and private sources.
  Health indicators are valid variables used for the assessment
of community health.
 Community diagnosis is done using the health indicator
tools which must be:
✓Valid
Health ✓Reliable
Indicators ✓Sensitive

✓Specific

✓Relevant, and

✓Feasible
  Morbidity indicators
 Mortality indicators
 Disability rates
 Nutritional status indicators
Classification  Health care delivery indicators
of Health  Utilization rates

Indicators  Indicators of social and mental health

 Environmental indicators
 Socio-economic indicators
 Health policy indicators
 Indicators of quality of life, etc.
  It helps to identify the common problems or diseases, which
affects the people but are easily preventable in the community.
 It can be a significant step for improvement of rural community
health.
Importance of  It helps to access the group of underprivileged people with limited
Community access to available facilities due to financial and social
discriminations, or other reasons.
Diagnosis  It helps to disclose the hidden problems faced by community not
perceived by the people.
 It aids to impart knowledge and attitudes to turnover people’s
problems towards a clear solution
Methods of
Community Diagnosis
 Observation
 it involves observing their surroundings , living condition eating
habit, life pattern so as to avoid wrong impression.
Ways of
gathering Interview
 it involves communicating with somebody e.g., household heads,
Information mothers . Creating a good rapport with the person so that he/she
will feel free to talk with you and give the correct information
about what you need
 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
Ways of
Review of existing record
gathering  Useful information can be obtained by reviewing existing records
Information particularly when trying to determine the population of a
community, the health facilities and the health personnel as well
as disease pattern in the area. This information can be obtained
from existing records. These records can be gotten through: local
government, maps, research records for diseases, report of
private organization.
  Community analysis is the process of examining data
to define needs strengths, barriers, opportunities,
readiness, and resources.
Community
Profile  The product of analysis is the “community profile”.

 In order to do this, it is helpful to categorize the data.

 Data may be categorized in the following ways:
 Demographic data: information such as population size, age, sex,
marital status, family size, birth rate, death rate, growth rate life
expectancy is in this category.
 Health problems of the community: leading cause of death,
Community leading cause of mortality, nutritional status, communication
between health and social welfare agencies, communication
Profile between these agencies and the people
 Disease: communicable and non-communicable dieses
information such as mode of spread, prevalence most affected
groups in the community, age/ sex distribution
  Nutritional status: availability of foods, food practices and habit,
breastfeeding, weaning, food selling places and food handlers
 Health facility: facilities and resources, road connection to health
centers, number that are available and distance to the community
Community  Socio-Economic: communication network, transportation
Profile network, educational level, poverty level income rate, types of
industry, occupation common in the community
 Environmental: physical/topographical characteristics water
supply waste disposal, air water rand land pollution
 Cultural: ethnicity, language, religion, race… etc
 1. Collecting background information of various communities
2. Selecting a target community
3. Initial Planning:
- Establishing the Community diagnosis survey objectives,
Steps in - Scope of the survey (how much detailed information is needed?
how big area should it cover?
conducting - Selection of appropriate indicators
- Selecting appropriate time of the year (seasonality might affect
Community results)

Diagnosis - Identifying resources (human resources, financial resources, etc.)

4. Sampling: Selection of study population from reference

population; probability and non-probability sampling (usually
we use probability sampling methods in community diagnosis
survey)
 5. Developing tools and techniques:
 Household questionnaire
 Anthropometric instruments (weighing machines, salter scales,
MUAC tapes etc.)
Steps in  Observation checklist
 Key-informant interview guidelines (e.g., for interviewing HF in-
conducting charges, school teachers, local leaders, traditional healers etc.)
 In depth interview guidelines (patients visiting health facility)
Community 6. Entry to the community, Rapport Building, Social Mapping
Diagnosis 7. Data collection
8. Data entry and processing:
Data validation, Data sorting and sequencing, summarizing, coding,
aggregation, computing etc.
 9. Data analysis and Interpretation:
Descriptive and Inferential analysis, in community diagnosis we usually perform
Steps in conducting A community diagnosis (CONT`D)
descriptive analysis (frequency, ratio, proportions, percent, etc.) Data can be displayed in
the form of sentences, tables, graphs, charts.

10. Need identification: Determining observed needs and felt needs, and then finalizing
the real needs of the community and ultimately identifying the necessary measures
to solve them.

11. Prioritizing needs with community people:

Not all needs can be met. There are certain criteria to be used to prioritize the health
needs of the community, which are listed as follows:
 Equity
 Burden of disease (Magnitude, severity)
 Cost effectiveness
 Community interest
 Existing capacity
 National Priority
 Sustainability
 Time for evaluation
Steps in conducting A community diagnosis (CONT`D)
12. Dissemination:
The production of the community diagnosis report is not an end in
itself, efforts should be put into communication to ensure that
targeted actions are taken. The target audience for the community
diagnosis includes policy makers, health professionals and the general
public in the community. The report can be disseminated through
various channels

13. Follow up
  The involvement of the members of the community in
any health project has proven to be effective.
Conclusion
 These projects are more successful and sustainable
when the collaboration of the community is
encouraged.
  Ehsan Ullah Tareen Mayeh Abu Omar, (1997),"Community entry -
an essential component of participation", Health Manpower
Management, Vol. 23 Iss 3 pp. 97 - 99
 Simpson J, Omaleki V (2019) Community Entry Best Practices at
Project Concern International: Experiences from Implementing
Staff.
References  Vermeulen, N., Amod, A., Bell, T., Cloete, A., Johannes, T.,
Williams, K. (2015) Students' fieldwork experiences of using
community entry skills within community development. South
African Journal of Occupational Therapy, 45(2), 51-55
 Baker, E. A., Homan, S., Schonhoff, R., & Kreuter, M. (1999).
Principles of practice for academic/practice/community research
  Clark, N. M. (1999). Community/practice/academic partnerships in
public health. American Journal of Preventive Medicine, 16(3S),
18- 19.
 Community Entry Best Practices at Project Concern ...
www.pciglobal.org/wp-content/uploads/2019/06/PCI-Community-
Entry-White-Paper-Final-May-31-2019.pdf.
References  Fabayo, C. O., Olubiyi, S. K., & Adebanjo, A. (2010). NSS327
COMMUNITY HEALTH NURSING [Scholarly project]. In
Community Health Nursing. Retrieved from www.nou.edu.ng
 Smith, Shannon L., et al. “Community Entry in Conducting Rural
Focus Groups: Process, Legitimacy, and Lessons Learned.” The
Journal of Rural Health, vol. 18, no. 1, 2002, pp. 118–124.,
doi:10.1111/j.1748-0361.2002.tb00883.x.