Community Entry and Organisation: Lecture One

COMMUNITY ENTRY AND
ORGANISATION
LECTURE ONE
MARK K. ANANGA
Population and Behavioural Sciences
School of Public Health
UHAS
DATE: 22nd Jan, 2016

COMMUNITY NEED ASSESSMENT
Objectives:
By the end of the lecture students will:
 Identify the various types of needs of a community ; and
 Describe the process of assessing and prioritising the primary health

care needs of a community
Content:
 The concept and types of needs in community development
 The importance of assessing needs; and
 The process or methods of assessing and prioritising primary health care

needs of a community
Needs and Types of Needs
The concept of needs describes the situation or circumstances in

which something is lacking, or necessary or requiring some course
of action to provide satisfaction.
 In community mobilization, it is necessary to clearly specify the needs.
 Avoid any needs that

 Vague
 Ill defined
 Broad and
 Abstract.
Felt Needs
These are what people “feel” or their wants.
They may only be the

 feelings of the individual people or
 wants shared by groups or majority of people in the community.
These may therefore

 be an individual’s or community’s assessment of the present situation
 discovering what is lacking and
 realizing the potential for change.
Felt needs may be expressed informally within the community.

Expressed Needs
These are needs that have been moved from the level of being felt to
that of being brought to the attention of authorities at various
levels
Expressed by
Requests
Complaints
Petitions etc.
These needs have been spoken out or expressed in writing.

Organizational Determined Needs

These are products of decisions emanating from external organizations to the
Community.
Organizational determined needs are what external organizations such as the:

 Ministry of Health
 Department of Community Development, etc. have decided the
community needs.
And may not necessarily reflect the felt needs of the people.
These needs are determined from outside the community.

Need Assessment
Needs assessment is a process
Finding out and prioritizing the local problems of a

community
Identifying the factors influencing such problems

Environmental
Socio-cultural
Structuring the resources available in the community to

solve the problems.
Need Assessment
Needs assessment is a process of finding out and prioritizing the local
problems of a community, identifying the environmental and socio-
cultural factors influencing such problems and structuring the resources
available in the community to solve the problems
Health needs assessment is a systematic method for reviewing the

health issues facing a population, leading to agreed priorities and
resource allocation that will improve health and reduce inequalities
Community health needs assessment is a process that:

‒ describes the state of health of local people;
‒ enables the identification of the major risk factors and causes of ill health;
and
‒ enables the identification of the actions needed to address these.
Health Need Assessment - Importance
Why undertake HNA?

HNA is a recommended public health tool to provide evidence about
a population on which to plan services and address health inequalities
HNA provides an opportunity to engage with specific populations
and enable them to contribute to targeted service planning and resource
allocation
HNA provides an opportunity for cross-sectoral partnership working
and developing creative and effective interventions
It enables health workers and their partners to gather and disseminate
information on the health and well being of the community;
Need Assessment - Importance
 Promotes the collection of appropriate information for effective

program planning;
 It helps to raise awareness of the key issues confronting the people

in the community and among the partners in community base health
services delivery;
Community participation in assessing health needs creates the

foundations for the people’s active participation in the
implementation of future health programs.
The process of Conducting a Need Assessment
Gathering background information about the community
Assessing the status of the community and its resources
Assembling the information about the health conditions in the

community
Assembling information about the health resources in the

community
Gathering information about health behaviour of community

members
Assessing the status of functioning health programs in the

community
Steps in Conducting a Need Assessment
Step 1
Getting started
What population?
What are you trying to achieve?
Who needs to be involved?
What resources are required?
What are the risks?
Step 2
Identifying health priorities
Population profiling
Gathering data
Perceptions of needs
Identifying and assessing health
conditions and determinant factors
Step 3
Assessing a health priority for action
Choosing health conditions and determinant factors with the
most significant size and severity impact
Determining effective and acceptable interventions and
actions
Step 4
Planning for change
Clarifying aims of intervention
Action planning
Monitoring and evaluation strategy
Risk-management strategy
Step 5
Moving on/review
Learning from the project
Measuring impact
Choosing the next priority
Methods of Needs Assessment
Two conventional methods of collecting information in a needs assessment are
available.
1. Review of available literature/secondary sources such as:

 Annual reports from the DHMT and other related organizations;
 Health facility records;
 Special health related project reports;
 News papers and Health Journals’ and
 Annual records from the District Births and Deaths Registry.

Methods of Needs Assessment

2. Collection of primary information using various Participatory Learning and
Action tools such as:

 Household census;
 Community mapping;
 Sample surveys;
 Focus Group Discussions;
 Transect Walks and Observation;
 Interviews with Community leaders and people.

Methods of Needs Assessment -Information Areas to
Consider
1. Background Information about the Community:

 Population characteristics/History of the community, Customs and Beliefs;
 Physical characteristics – roads networks and transportation;
 Economic activities;
 Communication – posts and telecommunication;
 Housing pattern;
 Educational facilities;
 Nutrition pattern; and
 Water and Sanitation facilities.

Consider
2. Political Structure:

 Traditional social and political structure at the community level;
 The formal political structures –

 The District Assembly
 Area councils
 Unit Committee; and
 Town/Village Development Committees.

Consider
3. Disease pattern:

 Most common causes of ill health;
 Most frequently diagnosed diseases;
 Ranking of health problems in order of importance;
 Special and unusual health problems;
 Number of health facilities;
 Number of health personnel; and
 Sources of finance for health programs.

Consider
4. Sickness and Health Behaviour:

 Actions taken by people to remain healthy and avoid ill health;
 Sources of relief for health problems;
 Role of TBAs and Traditional Healers; and
 Role of formal health care system.

Role of health Workers in Assessing Community
Health Needs
Most of the health needs of the community would have been
identified when the profile of the community is compiled.
In assessing and prioritizing these needs health workers such have
important roles to play
These roles lie in the fields of
Education
Support for and facilitation of community activities and
Serving as liaison between community leaders, health
authorities and other health delivery organizations in the
district.
Role of health Workers in Assessing Community
Health Needs
Some of the important activities they would be performing in fulfillment of
these roles include:
 Collecting information on health conditions with community members;
 Organize sessions for discussion of health needs with community members;
 Conduct regular health education activities to create awareness of health

issues;
 Hold meetings with chiefs and opinion leaders to discuss the health issues;
 Hold regular meetings with other groups such as mothers, young unmarried
women, young men, and fathers, etc. to discuss their specific health
problems;
 Discuss community health issues with DHMT and other health workers.
What are the challenges of HNA?
Working across professional boundaries – tackling territorial
attitudes preventing power or information sharing:
develop positive working relationships with colleagues within other
sectors
Lack of a shared language between sectors:
consider ways of jargon busting to keep communication accessible to
all involved
Lack of commitment from the top:
consider ways of communicating the value and benefits of the HNA to
key senior stakeholders
promote examples of successful HNA work in other organisations
What are the challenges of HNA?
Difficulties in accessing relevant local data:
consider trawling professional contacts for suggestions on accessing
relevant data
explore the national, regional and subregional data available from
health observatories
Difficulty in maintaining team impetus and commitment:
review progress and positively reinforce achievements
 ensure all team members are aware of achievements and progress
Difficulty in translating findings into effective action:
review findings in line with other known targets/objectives at
national, regional and subregional levels
consider findings in terms of short- and long-term action
– clarify what can be achieved in the short-term and build on
progress towards long-term goals
What are the benefits of HNA?
Benefits from undertaking HNAs can include:

‒ Strengthened community involvement in decision making
‒ Improved team and partnership working
‒ Professional development of skills and experience
‒ Improved communication with other agencies and the public
‒ Better use of resources.

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COMMUNITY ENTRY AND

DATE: 22nd Jan, 2016

 Describe the process of assessing and prioritising the primary health

 The importance of assessing needs; and

 The process or methods of assessing and prioritising primary health care

The concept of needs describes the situation or circumstances in

 In community mobilization, it is necessary to clearly specify the needs.

 Avoid any needs that

They may only be the

 wants shared by groups or majority of people in the community.

These may therefore

 discovering what is lacking and

 realizing the potential for change.

Felt needs may be expressed informally within the community.

These needs have been spoken out or expressed in writing.

Organizational Determined Needs

Organizational determined needs are what external organizations such as the:

These needs are determined from outside the community.

Needs assessment is a process

Finding out and prioritizing the local problems of a

Identifying the factors influencing such problems

Structuring the resources available in the community to

Health needs assessment is a systematic method for reviewing the

Community health needs assessment is a process that:

Why undertake HNA?

 Promotes the collection of appropriate information for effective

 It helps to raise awareness of the key issues confronting the people

Community participation in assessing health needs creates the

Assessing the status of the community and its resources

Assembling the information about the health conditions in the

Assembling information about the health resources in the

Gathering information about health behaviour of community

Assessing the status of functioning health programs in the

1. Review of available literature/secondary sources such as:

 Health facility records;

 Special health related project reports;

 News papers and Health Journals’ and

 Annual records from the District Births and Deaths Registry.

 Focus Group Discussions;

 Transect Walks and Observation;

 Interviews with Community leaders and people.

 Physical characteristics – roads networks and transportation;

 Communication – posts and telecommunication;

 Nutrition pattern; and

 Water and Sanitation facilities.

 The formal political structures –

 Unit Committee; and

 Town/Village Development Committees.

 Most frequently diagnosed diseases;

 Ranking of health problems in order of importance;

 Special and unusual health problems;

 Number of health facilities;

 Number of health personnel; and

 Sources of finance for health programs.

 Sources of relief for health problems;

 Role of TBAs and Traditional Healers; and

 Role of formal health care system.

 Organize sessions for discussion of health needs with community members;