Community diagnosis

Community Diagnosis

1. Community Diagnosis
Dr BibekRaj Parajuli
College of Medical Sciences,Bharatpur

2. Definition of a “Community”
A cluster of people with at least one common characteristic
(geographic location, occupation, ethnicity, housing condition……)
A group of people with a common characteristic or interest living
together within a larger society
A community is a whole entity that functions because of the
interdependence of its parts or subsystems. Eight subsystems plus
the community core are identified.
Community Core
1. Community core: history, socio-demographic characteristics, vital
statistics, values/beliefs/religions core
2. Eight subsystems:
Physical environment Health and social services
Communication Education
Safety and transportation Economics
Recreation Politics and government

3. Definitionof Community Diagnosis
Community Diagnosis is comprehensive assessment of the health
status of an entire community in relation to its social, physical and
biological environment in order to
a. Define existing problems
b. Determine available resources
(man and manpower)
c. Set priorities for planning, implementing and evaluating
health action by and for the community
It is based on thee collection and interpretation of the relevant
data e.g., demographic data , socio-economic data, morbidity,
mortality data , etc.
Community diagnosis generally refers to the identification and
quantification of health problems in a community as a whole in terms
of mortality and morbidity rates and ratios, and identification of their
correlates for the purpose of defining those at risk or those in need
of health care.
.

4. Objectives:
To collect demographic data and data on educational and
economical level and physical environment.
To reveal health related events and to calculate morbidity and
mortality rate (age, sex, cause specific)
To understand KAP (knowledge, attitude and practice) of community
regarding common health problems
To study existing health delivery system including traditional healer.
To discover and utilize local resources for community development.

5. Field orientation and
literature view
Formulation of study
methodology
evaluation
Social mapping of target
community
Field survey and data
collection
Data interpretation
Micro and macro
health project
Discussing findings with
community key people
to fine real needs
Steps

6. Importance
Identifies basic health needs and health problems of the community.
The felt needs are investigated and listed according to priority for
community treatment.
Quantifies health problems in term of mortality and morbidity rates
and ratio thus lays down priorities in disease control and prevention.
Quantification of morbidity and mortality serves as a benchmark for
the evaluation of health services at a later date.
Quantification can be a source of new knowledge about disease
distribution causation and prevention.
Helps in the understanding of social , cultural and environmental
characteristics of the community.

7. The Community Diagnosis Process
“A means of examining aggregate and
social statistics in addition to the
knowledge of the local situation, in order to
determine the health needs of the
community”

8. How is the community diagnosed ?
Community Analysis
Community analysis is the process of examining data to define
needs strengths, barriers, opportunities, readiness, and resources.
The product of analysis is the “community profile”.
To analyze assessment data is helpful to categorize the data. This
may be done as following:
Demographic
Environmental
Socioeconomic
Health resources and services
Health policies
Study of target groups.
Community is diagnosed using: Health Indicators

9. Characteristics of Indicators:
a. should be valid, i.e., they should actually measure what they are
supposed to measure;
b. should be reliableand objective, i.e., the answers should be the
same if measured by different people in similar circumstances;
c. should be sensitive, i.e., they should be sensitive to changes in
the situation concerned,
d. should be specific, i.e., they should reflect changes only in the
situation concerned,
e. should be feasible, i.e., they should have the ability to obtain data
needed, and;
f. should be relevant, i.e., they should contribute to the
understanding of the phenomenon of interest.

10. Classification of health Indicators
Mortality indicators
Morbidity indicators
Disability rates
Nutritional status
indicators
Health care delivery
indicators
Utilization rates
Indicators of social and
mental health
Environmental indicators
Socio-economic
indicators
Health policy indicators
Indicators of quality of life
Other indicators

11. Mortality Indicators
Mortality Rates
-The traditional measures of health status.
-Widely used because of their ready availability.( death certificate is a legal
requirement in many countries)
Crude death rates
Specific death rates: age/disease
Expectation of life
Infant mortality rate
Maternal mortality rate
Proportionate mortality ratio
Case Fatality rate

12. Morbidity Indicators
Morbidity rates
-Data on morbidity are preferable,
although often difficult to obtain.
Incidence and prevalence
Notification rates
Attendance rates: out-patient
clinics or health centers.
Admission and discharge rates
Hospital stay duration rates

13. Disability Indicators
Disability ratesNo. of days of restricted activity
Bed disability days
Work/School loss days within a specified
period.
Expectation of life free of disability

14. Nutritional Indicators
Nutritional Status
Indicators
-It is an indicator of positive health
Anthropometrics measurements
Height of children at school entry
Prevalence of low birth weight
Clinical surveys: Anaemia,
Hypothyroidism, Nightblindness

15. Health Care Delivery Indicators
Health Care Delivery
Indicators
-Reflect the Equity / Provision of
health care
Doctor / Population ratio
Doctor / Nurse ratio
Population / Bed ratio
Population / per health center

16. Utilization Indicators
Health care utilization
Rates
-Extent of use of health services
-Proportion of people in need of service
who actually receive it in a given
period
Proportion of infants who are
fully immunized in the 1
st
year
of life.
i.e..immunization coverage.
Proportion of pregnant women
who receive ANC.
Hospital-Beds occupancy rate.
Hospital-Beds turn-over ratio

17. Social/Mental Health Indicators
Indicators of Social and
Mental Health
-Valid positive indicators does not often
exist
-Indirect measures are commonly used
Suicide & Homicide rates
Road traffic accidents
Alcohol and drug
abuse.

18. Environmental Indicators
Environmental health
Indicators
-Reflect the quality of environment
Measures of Pollution
The proportion of people
having access to safe water
and sanitation facilities
Vectors density

19. Socio-economic Indicators
Socio-economic
Indicators
-Is not a direct measure of health
status.
-For interpretation of health care
indicators.
Rate of population increase
Per capita GNP
Level of unemployment
Literacy rates -females
Family size
Housing condition e.g. No. of
persons per room

20. Health Policy Indicators
Health Policy Indicators
-Allocation of adequate resources.
Proportion of GNP spent on health
services.
Proportion of GNP spent on health
related activities.
Proportion of total health resources
devoted to primary health care

21. Other Indicators
Other health
indicators
Indicators of quality of life.
Basic needs indicators.
Health for all indicators.

22. Source of data
1.Primary
Community visit
2. Secondary
Office of magistrate

23. Clinical vs. community diagnosis
Features Clinical diagnosis Community diagnosis
History taken from Patient family Formaland informal
leaders , community
members
visits Patient comes to doctorInvestigator goesto
community
To detect health problemExamine patient Observation in
community
Investigation Lab test and x-rays Data collection, surveys
and secondary sources
Preliminary diagnosisdoctor’s initial evaluation
to patient
Data processing and
analysis

24. Clinical vs. community diagnosis
(cont…)
Feature Clinical diagnosisCommunity diagnosis
Concerned with Disease only in sick Disease pattern in whole
population
Explain diagnosis conversation Data presentationto
community
Start treatment Medication, surgery Action plan
Mutual relationship Patient follow doctor’s
order
Community co-operation
on collaboration enlisted
Behavior change May or may not be
needed
Lasting improvement in
community health status
not possible without its
community
Who is in control Doctor Community
Follow patient Assess progress,
confirm diagnosis,
change diagnosis and
treatment
Monitor, evaluate and
plan new health action

25. Merits of community for the control of the disease
It prioritizes the health problem thus allowing to know the most common
disease susceptibility and disease of greatest concern to community
helps to make intelligent use of money, manpower and materials.
Helps to discover hidden health problems in area which health personnel
are not aware of.
Making people aware of their true health problems. For e.g. people may
demand health post for high prevalence of hookworm anemia not knowing
that their main problem is open defecation.
Make people aware of the reason for their health problem for e.g. defecation
near a water source leads to water pollution and thus to dysentery.
Make people realize what they themselves can do as their own health
problems.
Helps to find those very people who are in particular need of health
education and services.
Thus it helps to control diseases.
THANK-YOU