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CommunityEmpowermentinHealthDrJohnnyPangkasDrPH(UNIMAS)
DHOBetong
BetongStateComplex
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THE17SUSTAINABLEDEVELOPMENTGOALS
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OverviewofpresentaFon
• Overview• Approach• Benefits• ValuesandDimensionofCommunityEmpowerment• ExamplesofStudies• Sharing• Conclusion
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DefiniFon
• CommunityempowermentreferstotheprocessofenablingcommuniFestoincreasecontrolovertheirlives.
• "CommuniFes"aregroupsofpeoplethatmayormaynotbespaFallyconnected,butwhosharecommoninterests,concernsoridenFFes.
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DefiniFon
• WHOdefinesempowermentas“aprocessthroughwhichpeoplegaingreatercontroloverdecisionsandacFonsaffecFngtheirhealth”
• WorldBankdefiniFon:processofincreasingcapacityofindividualsorgroupstomakechoicesandtotransformthosechoicesintodesiredacFonsandoutcomes.
WallersteinN(2006).Whatistheevidenceofeffec0venessofempowermenttoimprovehealth?Copenhagen,WHOregionalofficeforEurope(HealthEvidenceReportNetwork.
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• CommunitydefiniFon• AcommondefiniFonofcommunityemergedasagroupofpeoplewithdiversecharacterisFcswhoarelinkedbysocialFes,sharecommonperspecFves,andengageinjointacFoningeographicallocaFonsorseZngs.
• Empowerment• CommunityempowermentreferstotheprocessofenablingcommuniFestoincreasecontrolovertheirlives
CommunityEmpowerment
HealthPromoFonh[p://www.who.int/healthpromoFon/conferences/7gchp/track1/en/
Green&Mercer.AmericanJournalofPublicHealth|December2001,Vol91,No.12
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History
• 1978,WHO’sAlmaAltafirstarFculatedthegoalsofcommunityparFcipaFonandequity
• ExtensiontoempowermentintheO[awaCharter• UnitedNaFonMDG,women’sempowermentandhealthintervenFons
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ParFcipaFon• CommunityparFcipaFoncreatesa‘sociallearning’processwherebyprofessionalsandlocalpeoplelearnfromeachotherandbuildworkingpartnershipsforsustainableimprovements.
Thantzelal
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Theissues
• DispariFes,• socialexclusion• absolutepoverty
WallersteinN(2006).Whatistheevidenceofeffec0venessofempowermenttoimprovehealth?Copenhagen,WHOregionalofficeforEurope(HealthEvidenceReportNetwork.
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Theissues
• LimitaFonsofhealthprofessionalsinimprovinghealth• SelfCare(SC)andcommunityparFcipaFon• Selfcare
• LaypersonfuncFonsonhis/herbehalfinhealthpromoFonandprevenFonandindiseasedetecFonandtreatmentatthelevelofprimaryhealthresourceinthehealthcaresystem
KhanidiraKumarBhuyan,BMCPublicHealth2004
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RaFonales
• HealthisessenFalforhumansurvivalandcapability
• CommunityparFcipaFon–efficientandcosteffecFve
• Increaseskillsandknowledgeofpeople
Thantzetal2013,MalaysianJournalOfPublicHealth
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AzwarA.TherolesofprimarycarephysicianinAchievingMDGS.JMAJ.52(6):375-379.
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Approach
• Empowermentenhanceindividualcompetenceandselfesteemwhich,inturn,increasepercepFonsofpersonalcontrolwhichhasadirecteffectonimprovinghealth.
• IndividualacFon–smallmutualgroups–organizaFons–socialandpoliFcalacFons.
• CommunityorganizaFons–opportunityforthememberstogainskillsandcompetenciesnecessarytoallowthemtomovetowardsachievinghealthoutcomes
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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.
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Bhuyan2004.BMCPublicHealth
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Bhuyan2004.BMCPublicHealth
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Approach
LowndessandPrache[,2008
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ContraCosta,HealthServices
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CollaboraFonwithotheragencies
• Districtoffice• Localcouncil• PoliFcalleaders• NGOs• Otheragencies
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CommunityDevelopmentValues
• Recognisingtheskills,knowledgeandexperFseLearning• ChallengingdiscriminaFonandoppressivepracFcesEquality• InvolvementofpeopleintheissuesParFcipaFon• WorkingtogethertoidenFfyandimplementacFonCo-operaFon• Humanrights,meettheirneedsandgreatercontroloverdecisionmakingprocessSocialjusFce
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DimensionsofCommunityEmpowerment
• Increasepeople’sknowledgeandskillsConfident• PromoteequalityandopportunityInclusive• BringpeopletogetheraroundcommonissuesOrganised• PromotepartnershipCo-operaFve• EncourageandequipcommuniFestotakepartInfluenFal
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Benefits
• Improvementinpeoplehealth• Moreefficientuseofresources• Findingnewwaystodeliverservices
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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.
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Expectedoutcomes• AWorldHealthOrganizaFon(WHO)EuropepublicaFononcommunityparFcipaFoninlocalhealthandsustainabledevelopment10:12-13summarisestheraFonaleto:
• increasedemocracy,asparFcipaFonisbothabasicrightandanessenFalelementofciFzenship
• combatsocialexclusionbygivingpeopleavoice,especiallymarginalisedpopulaFons• empowerindividualsandcommuniFesandenablethemtogainmorecontrolovertheirlives
• mobilisecommunityresourcesandenergy• developholisFcapproaches• aiddecision-makinganddesignmoreeffecFveservicesthroughbe[erlocalintelligence
• ensurecommunityownershipandulFmatelythelong-termsustainabilityofprogrammes
Gregson,RachelwithCourt,Liz(2010).BuildinghealthcommuniFes:Acommunityempowermentapproach.
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Expectedoutcomes
• Evidentinbe[erhealthandimprovedservices• Non-healthprofessionalsencouragetoworkoutwhatbeenhealthymeansmeanttothem
• ReducFonofhealthcarecost
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CommunityEmpowermentStudies
• AcommunitybasedintervenFonthrough1stop-centreforhealth:AcommunityempowermentapproachinMalaysia
• ReduceNCDriskfactors• 107people,PantaiPeringgitCommunity• Conductedby10volunteers• Obesityreduced• ReducedBP• WalkingFmefor5KMalsoreduced.
GenevaHealthForumArchive
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• Communityempowerment–asuccessfulmodelforprevenFonandnoncommunicablediseasesinIndia–theChenaiUrbanPopulaFonStudy
• AsiadColony• EducaFononbenefitsonphysicalacFviFes–publiclecturesandmassvideo• Result–increasedinnumberofpeopleinvolvedinphysicalacFviFes• IncreaseinnumberofpeoplewhowalkthreeFmesaweek
CommunityEmpowermentStudies
Movanetal(2006).Communityempowerment–asuccessfulmodelforprevenFonofnoncommunicablediseasesinIndia–theChennaiUrbanPopulaFonStudy.JAssocPhysicianIndia
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Village Health Promoters
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TheProgramme
• Community-basedhealthprogramme• IniFatedbySarawakHealthDepartmentin1983tohelpachieveHealthForAll
• Improvesaccesstoprimaryhealthcareinunder-servedareas
• AchievedthroughVillageHealthPromotersorVHP
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• 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
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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
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WKKConference
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KOSPEN
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Saringan kesihatan
41
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lokaliti
42
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Workplace
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KELABWARGAEMAS,KKSPAOH
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DENGUECONTROLACTIVITIES
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BAKAS–GravityFeed
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PANELPENASIHATKLINIK
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OTHERACTIVITIES
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WallersteinN(2006).Whatistheevidenceofeffec0venessofempowermenttoimprovehealth?Copenhagen,WHOregionalofficeforEurope(HealthEvidenceReportNetwork.
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THANKYOU
SEGULAISEJALAINUJUPENGERAI