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1. COMMUNITY DIAGNOSIS

2. COMMUNITY DIAGNOSIS
 For communities to be able to appreciate their
problems, needs or concerns, they need to have a
general picture of the situation in their
communities and this is done through community
diagnosis or CSA (Community situation analysis).
CDX: This is a process by which health
educator/health worker together with community
members identify health and health related
problems/concerns/needs of the community.

3. COMMUNITY DIAGNOSIS CONT’D
It answers the main three things ie.
Where the community is.
Where it wants to be.
How it will get there.
It is made up of 2 main words i.e
Community and diagnosis

4. COMMUNITY DIAGNOSIS CONT’D
 Community: is a group of people with at least one
common characteristic (geographical location,
situation, ethnicity, housing condition) etc.
OR: A group of people with a common interest living
together within a larger society.
A community is a whole entity that functions because
of interdependence of its parts or subsystems and 8
subsystems are identified as follows.
Community is a group of people with similar
problems/interests/concerns living in a same
geographical area working towards achieving a
common goal

5. Community Core
1. Community core: history, socio-demographic
characteristics, vital statistics,
values/beliefs/religions.core

6. Eight Subsystems
2. Eight subsystems:
• Physical environment
• Education
• Safety and transportation
• Politics and government
• Health and social services
• Communication
• Economics
• recreation

7. COMMUNITY DIAGNOSIS CONT’D
DIAGNOSIS: means finding or discovering a
problem or concern or needs of a given society.
Community diagnosis: refers to the process where
community members learn about their problems or
needs or concerns and take appropriate action
based on their priority.
CDX: This is a process by which health
educator/health worker together with community
members identify health and health related
problems/concerns/needs of the community &
take action.

8. COMMUNITY DIAGNOSIS CONT’D
OR: CDX is the process of identification and
qualification of health related problems in a
community as a whole in terms of mortality and
morbidity rates and ratios as well as identification of
their correlates.
OR: CDX is a process of identifying health and health
related problems by the community members with
the help of health workers and look for possible
solutions.

9. COMMUNITY DIAGNOSIS CONT’D
Community diagnosis process:
These are means of examining aggregate and social
statistics in addition to the knowledge of local
situation in order to determine the health needs of
the community.

10. •How is the community
diagnosed?

11. COMMUNITY DIAGNOSIS CONT’D
Community analysis: Is the process of examining
data to define needs or strength or barriers or
opportunity or readiness and resources and the
product of analysis is community profile.
Analysis of data is helpful in categorization of data
which may be inform of demographic data,
environmental data, socio-economic data, health
resources and services, health policies and study of
target groups.
NB. Community is diagnosed using health indicators
which are variable used for assessment of
community health.

12. Community Analysis (cont.)
• 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.

13. COMMUNITY DIAGNOSIS CONT’D
Community core: history, socio-demographic
characteristics, vital statistics, values or beliefs or
culture or religion.
1. Physical environment
2. Education
3. Safety and transportation
4. Politics and government
5. Health and socio-services
6. Communication
7. Recreation

14. COMMUNITY DIAGNOSIS CONT’D
PURPOSE/REASONS/AIMS/OBJECTIVES OF
CARRYING OUT COMMUNITY DIACNOSIS
1. To analyze the health status of the community.
2. Evaluate the health resources, services and system
of care within the community.
3. Assess attitudes towards the community health
services.

15. CDX AIMS CONT’D
4. Identify priorities, establish goals and determine
courses of action to improve health status of the
community.
5. To establish the epidemiological baseline to the
measure improvement overtime.
6. To collect up to date information used for research
about selected health problems and their
determinants.

16. STEPS OF MAKING CDX
The following is a practical approach involving
community members, health trainees and health
workers that they may use to make a community
diagnosis.
1. Developing ideas about the community health
situation.
2. Review of available information about health
situation

17. STEPS OF MAKING CDX CONT’D
3. Take ideas to the community leaders, sell it to
them, get their ideas, develop consensus with them
and make an appointment with leaders to meet the
community members.
4. Take ideas to community members and sell the
ideas to them, get their ideas also, develop consensus
and let them know about the next plans.
5. Examine health problems and their determinants as
agreed upon by community members.

18. STEPS OF MAKING CDX CONT’D
6. Set objectives and take them to community
members, develop consensus and generate ways of
how data may be collected from the community.
7. Using ideas from the community members, decide
on strategies, activities and resources for data
collection e.g. A strategy can be a survey.
Activities may be designing data collection tool like
questionnaires, checklist, interviewer’s schedule or it
can be designed in instructional manual, or may be
selecting and training interviewers etc.
Resources can be 5Ms

19. STEPS OF MAKING CDX CONT’D
8. Make a budget based on activities and resources.
9. Develop and design a work plan including the cost
of the activities and resources.
10. Take a costed work, sell it to the community
members, generate consensus, identify locally
available resources in a community and determine
how the unavailable resources are to be achieved.
11. Mobilize both available and unavailable resources.
12. Print a questionnaire and the instructional
manual.

20. STEPS OF MAKING CDX CONT’D
13. Select and train interviewers
14. Carry out a pretest survey and make the necessary
adjustments in a questionnaire and the instructional
manual and appropriately advise the interviewers.
15. Carry out a pilot survey to test the feasibility of
data collection plans on the ground.
16. Do actual data collection.
17. Data analysis and identification of health
problems in the community through hand tallying or
hand sorting and present it in form of ratios, rates,
percentages, tables etc

21. STEPS OF MAKING CDX CONT’D
18. Make community diagnosis by prioritizing the
identified problems using the criteria of magnitude,
severity, public out cry, government policy, solvability.
19. Write a draft report including priority areas,
conclusions and recommendations and present it to
the community leaders and members or stake
holders.
20. Write a final report including ideas from
community members and other stake holders.
21. Disseminate the report to the community
members, district, NGO, journals, newspapers, library,
bookshop. e.t.c

22. TOOLS USED IN DATA COLLECTION
1. Questionnaire
2. Checklists
3. Interviewer’s schedules
Sources for CDX
There are two main categories of sources of data. i.e
1. Health related sources
2. Non health related sources

23. Health related sources
1. Health center and hospital records (OPD, IP
records)
Data related to area served by a hospital or health
center.
Major causes of illness in a community.
Health status indicators of community

24. • Community is diagnosed using:
Health Indicators

25. Indicators of health are variables used for
the assessment of community health.

26. Characteristics of Indicators:
• a. should be valid, i.e., they should actually measure what they are
supposed to measure;
• b. should be reliable and 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.

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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 1st year
of life.
i.e..immunization coverage.
 Proportion of pregnant women
who receive ANC.
 Hospital-Beds occupancy rate.
 Hospital-Beds turn-over ratio

34. 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.

35. 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

36. 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

37. 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

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

39. Thank You