drph (unimas) dho betongoutcome • weaknesses rectified • vhp programme was extended to more...

CommunityEmpowermentinHealthDrJohnnyPangkasDrPH(UNIMAS)

DHOBetong

BetongStateComplex

THE17SUSTAINABLEDEVELOPMENTGOALS

OverviewofpresentaFon

• Overview• Approach• Benefits• ValuesandDimensionofCommunityEmpowerment•  ExamplesofStudies•  Sharing• Conclusion

DefiniFon

• CommunityempowermentreferstotheprocessofenablingcommuniFestoincreasecontrolovertheirlives.

• "CommuniFes"aregroupsofpeoplethatmayormaynotbespaFallyconnected,butwhosharecommoninterests,concernsoridenFFes.

DefiniFon

• WHOdefinesempowermentas“aprocessthroughwhichpeoplegaingreatercontroloverdecisionsandacFonsaffecFngtheirhealth”

• WorldBankdefiniFon:processofincreasingcapacityofindividualsorgroupstomakechoicesandtotransformthosechoicesintodesiredacFonsandoutcomes.

WallersteinN(2006).Whatistheevidenceofeffec0venessofempowermenttoimprovehealth?Copenhagen,WHOregionalofficeforEurope(HealthEvidenceReportNetwork.

• CommunitydefiniFon•  AcommondefiniFonofcommunityemergedasagroupofpeoplewithdiversecharacterisFcswhoarelinkedbysocialFes,sharecommonperspecFves,andengageinjointacFoningeographicallocaFonsorseZngs.

•  Empowerment•  CommunityempowermentreferstotheprocessofenablingcommuniFestoincreasecontrolovertheirlives

CommunityEmpowerment

HealthPromoFonh[p://www.who.int/healthpromoFon/conferences/7gchp/track1/en/

Green&Mercer.AmericanJournalofPublicHealth|December2001,Vol91,No.12

History

•  1978,WHO’sAlmaAltafirstarFculatedthegoalsofcommunityparFcipaFonandequity

•  ExtensiontoempowermentintheO[awaCharter• UnitedNaFonMDG,women’sempowermentandhealthintervenFons

ParFcipaFon• CommunityparFcipaFoncreatesa‘sociallearning’processwherebyprofessionalsandlocalpeoplelearnfromeachotherandbuildworkingpartnershipsforsustainableimprovements.

Thantzelal

Theissues

• DispariFes,• socialexclusion• absolutepoverty

WallersteinN(2006).Whatistheevidenceofeffec0venessofempowermenttoimprovehealth?Copenhagen,WHOregionalofficeforEurope(HealthEvidenceReportNetwork.

Theissues

•  LimitaFonsofhealthprofessionalsinimprovinghealth•  SelfCare(SC)andcommunityparFcipaFon•  Selfcare

•  LaypersonfuncFonsonhis/herbehalfinhealthpromoFonandprevenFonandindiseasedetecFonandtreatmentatthelevelofprimaryhealthresourceinthehealthcaresystem

KhanidiraKumarBhuyan,BMCPublicHealth2004

RaFonales

• HealthisessenFalforhumansurvivalandcapability

• CommunityparFcipaFon–efficientandcosteffecFve

•  Increaseskillsandknowledgeofpeople

Thantzetal2013,MalaysianJournalOfPublicHealth

AzwarA.TherolesofprimarycarephysicianinAchievingMDGS.JMAJ.52(6):375-379.

Approach

•  Empowermentenhanceindividualcompetenceandselfesteemwhich,inturn,increasepercepFonsofpersonalcontrolwhichhasadirecteffectonimprovinghealth.

•  IndividualacFon–smallmutualgroups–organizaFons–socialandpoliFcalacFons.

• CommunityorganizaFons–opportunityforthememberstogainskillsandcompetenciesnecessarytoallowthemtomovetowardsachievinghealthoutcomes

Community Analysis

•  Community analysis involves reviewing demographic, health and other essential data about the community or population and how it compares to national or regional averages.

•  This initial assessment of the community helps identify key stakeholders, target groups and provides a basis for community engagement.

•  Once the target group is identified, develop a clear description of the target group to further focus the next steps of problem and determinant analysis.

Bhuyan2004.BMCPublicHealth

Bhuyan2004.BMCPublicHealth

Approach

LowndessandPrache[,2008

ContraCosta,HealthServices

CollaboraFonwithotheragencies

• Districtoffice• Localcouncil• PoliFcalleaders• NGOs• Otheragencies

CommunityDevelopmentValues

• Recognisingtheskills,knowledgeandexperFseLearning• ChallengingdiscriminaFonandoppressivepracFcesEquality• InvolvementofpeopleintheissuesParFcipaFon• WorkingtogethertoidenFfyandimplementacFonCo-operaFon• Humanrights,meettheirneedsandgreatercontroloverdecisionmakingprocessSocialjusFce

DimensionsofCommunityEmpowerment

•  Increasepeople’sknowledgeandskillsConfident• PromoteequalityandopportunityInclusive• BringpeopletogetheraroundcommonissuesOrganised• PromotepartnershipCo-operaFve• EncourageandequipcommuniFestotakepartInfluenFal

Benefits

•  Improvementinpeoplehealth• Moreefficientuseofresources•  Findingnewwaystodeliverservices

Capacitybuilding

•  Community engagement as a strategy within a capacity building approach can thus be described as a ‘bottom-up’ approach, informed by and owned by the community.

•  Capacity building can present challenges for health professionals because it necessarily involves health practitioners relinquishing control and working towards a role obsolescence.

•  Capacity building can be seen as a central health promotion strategy and is a continual process that acts in parallel at each point along the public health intervention management cycle.

Expectedoutcomes•  AWorldHealthOrganizaFon(WHO)EuropepublicaFononcommunityparFcipaFoninlocalhealthandsustainabledevelopment10:12-13summarisestheraFonaleto:

•  increasedemocracy,asparFcipaFonisbothabasicrightandanessenFalelementofciFzenship

•  combatsocialexclusionbygivingpeopleavoice,especiallymarginalisedpopulaFons•  empowerindividualsandcommuniFesandenablethemtogainmorecontrolovertheirlives

•  mobilisecommunityresourcesandenergy•  developholisFcapproaches•  aiddecision-makinganddesignmoreeffecFveservicesthroughbe[erlocalintelligence

•  ensurecommunityownershipandulFmatelythelong-termsustainabilityofprogrammes

Gregson,RachelwithCourt,Liz(2010).BuildinghealthcommuniFes:Acommunityempowermentapproach.

Expectedoutcomes

•  Evidentinbe[erhealthandimprovedservices• Non-healthprofessionalsencouragetoworkoutwhatbeenhealthymeansmeanttothem

• ReducFonofhealthcarecost

CommunityEmpowermentStudies

• AcommunitybasedintervenFonthrough1stop-centreforhealth:AcommunityempowermentapproachinMalaysia

•  ReduceNCDriskfactors•  107people,PantaiPeringgitCommunity•  Conductedby10volunteers•  Obesityreduced•  ReducedBP• WalkingFmefor5KMalsoreduced.

GenevaHealthForumArchive

• Communityempowerment–asuccessfulmodelforprevenFonandnoncommunicablediseasesinIndia–theChenaiUrbanPopulaFonStudy

•  AsiadColony•  EducaFononbenefitsonphysicalacFviFes–publiclecturesandmassvideo•  Result–increasedinnumberofpeopleinvolvedinphysicalacFviFes•  IncreaseinnumberofpeoplewhowalkthreeFmesaweek

CommunityEmpowermentStudies

Movanetal(2006).Communityempowerment–asuccessfulmodelforprevenFonofnoncommunicablediseasesinIndia–theChennaiUrbanPopulaFonStudy.JAssocPhysicianIndia

Village Health Promoters

TheProgramme

• Community-basedhealthprogramme•  IniFatedbySarawakHealthDepartmentin1983tohelpachieveHealthForAll

•  Improvesaccesstoprimaryhealthcareinunder-servedareas

• AchievedthroughVillageHealthPromotersorVHP

•  Serve as entry points through which we can build smart partnerships & encourage communities to take responsibility for their own health

The Concept

Belikau longhouse, Kapit

TheEvaluaEon•  TwomajorevaluaFonsdonesofar,bothincollaboraFonwithInsFtuteforMedicalResearch:

•  FirstevaluaFonin1985–1986

•  SecondevaluaFonin2000-2001

Outcome •  Weaknesses rectified •  VHP programme was extended to more

villages throughout Sarawak

Conclusion of evaluation •  VHP programme is still relevant, especially in the

remote areas in Sarawak •  Some changes in focus needed to keep it in tandem

with current health scenarios

WKKConference

KOSPEN

Saringan kesihatan

41

lokaliti

42

Workplace

KELABWARGAEMAS,KKSPAOH

DENGUECONTROLACTIVITIES

BAKAS–GravityFeed

PANELPENASIHATKLINIK

OTHERACTIVITIES

WallersteinN(2006).Whatistheevidenceofeffec0venessofempowermenttoimprovehealth?Copenhagen,WHOregionalofficeforEurope(HealthEvidenceReportNetwork.

THANKYOU

SEGULAISEJALAINUJUPENGERAI