Community- Based Health Programs: Struggles for Health, Education, and Social Care

This presentation aims to share lessons and insights, pieces of evidence on what works and what does not work in community health development work. For almost four decades, I have been part of community-based health programs (CBHPs) in the Northern Part of the Philippines, taking on the struggle for health, education and social care.  This presentation will focus on my stories from the field arising from my involvement with CBHPs, as these grew painstakingly through the years,  ushering in hope for social change.  Since 1973, non-governmental CBHPs have been part of the Philippine health care system.  In the beginning, these programs centred mainly on teaching paramedics in far-flung, neglected rural communities.  In due time, CBHPs learned to uphold, support and eventually become part of the common people's aspirations and struggles.

A community-based health program involves a community and its focus of attention is health.  Involvement of the community does not mean a passive involvement where the people are the mere recipients of the services which the program offers.  Rather it means the participation of the community in all aspects and stages of the program.  Involving the community means involvement of people.  The primary and ultimate wealth of the community are its people.  A community-based health program therefore gives importance to people.  It is people-oriented. The essential elements of community-based health programs which have been recognised and described include the following: 1. The community knows, feels and accepts responsibility for community health, not just the health of the individual; 2. The community taps and develops its own resources to meet health needs, including personnel and material resources, organizations and institutions at all levels; and 3.  Community priorities are the priority focus of the programs.

My story will walk the participants through the history of CBHPs, which I have journeyed namely:   Stage I: (1973-1975) Conceptualisation of a Developmental Approach to Health Care For and By the People; Stage II: (1976-first half, 1977) Promotion of a New Approach to Health Care; Stage III: (Second half, 1977-1978) Community Organization: the Backbone and Key to Success; Stage IV: (1979-1980) The Growth of People's Organization through Refined Organising Methods; Stage V:  (1981-1985)  Growth and Strengthening of CBHPs; Stage VI: (1985- 1988) Setback Years; and Stage VII: (1989-present) Reorientation and Reaffirming Commitment to CBHPs. My journey highlights the commitment to CBHP's holistic approach to health care and how this led the people  to challenge existing structures  and transcend "traditional" roles.

My journey with community health programs affirms the hoslitic approach of CBHPs. A community-based health program recognises that the health problems of any community are inter-related with the economic, political and cultural problems of society.  Health is thus seen as only one component of the development  of the community.  Rather than emphasise the acquisition of high quality and sophisticated medical skills and treatment, priority is placed on using health as a way to motivate people to improve their standard of living and their quality of life.  The people start to see that their health problems are related to food production problems, nutrition, water supply, housing, education, income and its distribution, employment, communication and transport, and ultimately to political decisions.  Physical health is not the only concern, but also mental and social health as well.  The total well-being of a community and its people is targeted.

In a community-based health program, the initial goals, objectives and plans are open-ended and flexible.  It considers the community's felt needs and not those defined by the health professionals.  The program staff try to inspire, advise, motivate and demonstrate, but do not make decisions for the community.  The community is strongly involved in all areas where decisions-making is needed.  Community-based health programs are therefore built from the grassroots and are not handed down by the medical doctor or by institutions.

Any program directed towards the community will not work without the essential element of community awareness and community involvement in the planning and implementation of such a program. It must involve those who suffer from disease and poverty, and it must let them take the decisions and responsibility for their own health care.  Unless the people in the community comprehend what the program is all about, prior preparation and involvement with the people will not succeed.  Such programs may but only for a short while. In community-based health programs, the basic attitude is working with the community, and not giving to the community to improve health.  Finally, health by the people rather than health to the people is aimed at.  The communities will be, therefore, on their way to becoming self-governing, self-sustaining and self-reliant.

This story is a celebration of committed health professionals and people's efforts and achievements in their movement for social change. These lessons found their way to curricular development and changes as well as related learning experiences of student nurses. These form evidences of tested strategies that aid community health nurses more relevant and effective in the delivery of community health services.