Serve the People Model of Community Health Development Work: Towards a Caring Framework

Purpose: Community health development workers (CHDWs) live and work in a society that is characterised by poverty, exploitation and oppression.  This presentation aims to describe a model of caring grounded from extensive health work with health professionals, including an ethnographic study among 20 community health nurses (CHNs) in the Northern Philippines. It describes how the CHDWs have come face to face with the effects of the continuing struggle of the people for social justice, democracy, national independence, material and cultural progress and peace.  Within this context, it is imperative that the health profession identifies its position.  Only then can it make meaningful innovations, contribution to change and take on relevant roles and challenges.

Methods: This model was derived from almost a year of focused ethnography among community health nurses and community health development workers and then augmented with many years of continued development work in the Northern part of the country. The eethnographic field research involved face-to-face interviewing, with data collection and analysis taking place in the natural setting.  I utilized Shaffir and Stebbin (1991) four stages of field experiences: a)  entering the field setting; b) learning how to play one's role within the setting or learning the ropes; c) maintaining and sustaining the relationships that emerged; and d)  eventually leaving the setting. These stages were not necessarily sequential or distinct.  Although analytically separable, these stages merge and interweave at various points of the research as I concurrently performed different tasks associated with each stage. All throughout the interactions, I utilized the critical social theory lens as I immersed with the participants of the study.

A combination of various data collection strategies was chosen: participant observation supplemented with unstructured and semi-structured interviews, focus group interviews, and review of documents.  The triangulation of data with the use of a combination of methods and data sources offered the opportunity to validate and cross-check findings. In the study, the combined process of reflection, imaginative thinking and systematic sifting and analysis of evidence was done until coherent themes and subthemes emerged that guided the study.

Results: The Serve the People (STP) Model of Community Health Development (CHD) reflects personal stories and concrete experiences of the participants of the study. This model was developed from the themes and subthemes that emerged namely: Context Setting and Approach to Health Work; Community Development Framework; Implementation and Evaluation; Method of Work: Action-Reflection Cycle and Empowerment; Roles of Development Health Workers; and Challenges to the Health Care Practice in the Community. The model implies a commitment which CHDWs must possess and serves as a guideline for CHDWs in caring and working with the people. It promotes and upholds the following caring principles: 1) views health holistically or as a social phenomenon; 2) diagnoses community problems and needs collectively; 3) focus of interventions are those that are identified by the people and not those felt and perceived by the CHD; 4) advocates methods of health work that are comprehensive, relevant, participatory, democratic, liberating, promotive of critical thinking, and empowering; and 5) identifies outcomes that are clear and shared among the nurses and the people. The model's name was based on the firm belief of the CHDWs that the health profession exists for the people.

Conclusion: This caring model is derived from personal and concrete experiences of the participants of the study.  It was developed as a contribution to the community practice-based knowledge of CHD work.  It poses challenges to nurse educators, practitioners and researchers.