Micro Health Project

Micro Health Project is the implementation part of any community health diagnosis. It helps to mitigate the community health needs through community participation and maximum utilization of the community resources. The micro-health project is conducted on the prioritized real need(s).

Importance of MHP

-       To prevent and control health problem(s) of the community

-       To make the people aware about the community health problems

-       To mobilize the locally available community resources

-       To increase community participation

-       To reduce the dependency of the community towards the external donors

Micro-Health Project Process

Planning of Micro Health Project

Key elements of MHP Planning

- Overview(Short summary of the MHP)

- Objectives

- Schedules (Time, date, venue, duration, episodes.)

- Resources (Budget, Cost monitoring and control, Personnel requirements )

- Evaluation Methods (Be evaluated against the standard.)

- Potential Problems (Anticipate potential difficulties.)

MHP Planning framework

SN	Health needs/ objectives	Activities	Target group & Number	Venue, date, time & episodes	Methods & materials	Evaluation indicators

Implementation of Micro Health Project

Implementation is the process of putting the plan into action. It is the process of mobilizing the resources to accomplish the predetermined goal. For the program implementation, the commitment from the community leader or resource person is taken to conduct the micro health project. The responsible person is oriented and trained to accomplish the tasks. Supervision and monitoring are done and feedback is given. Capacity building of the community people is facilitated and sustainability is maintained by forming effective committees

Steps of MHP Implementation

1. Ensure necessary planning is completed

2. Division of work among the team members

3. Publicize the activities

4. Delivery

5. Monitoring and supervision

Evaluation of Micro Health Project

Evaluation is the process of determining whether the project has accomplished its goals and objectives or not. Evaluating is comparing what has been done and what had been planned to be done previously. The steps of evaluation are as follows:

1. Defining the objectives of micro health project

2. Determining the criteria for evaluation technique

3. Identifying the evaluation technique

4. Resource preparedness for evaluation

5. Collecting the information, analyzing and interpreting the information

6. Recording and reporting

Process of Community Diagnosis

1.      Collecting background information of various communities

2.      Selecting a target community

3.      Initial Planning:

-   Establishing the Community diagnosis survey objectives,

-   Scope of the survey (how much detailed information is needed? how big area should it cover? E.g. Ward level, VDC level, district level),

-   Selection of appropriate indicators

-   Selecting appropriate time of the year (seasonality might affect results)

-   Identifying resources (human resources, financial resources, etc.)

4.  Sampling: Selection of study population from reference population; probability and non-probability sampling (usually we use probability sampling methods in community diagnosis survey)\

5.  Developing tools and techniques:

-   Household questionnaire

-   Anthropometric instruments (weighing machines, salter scales, MUAC tapes etc.)

-   Observation checklist

-   Key-informant interview guidelines (e.g. for interviewing HF in-charges, school teachers, local leaders, traditional healers etc.)

-   In depth interview guidelines (patients visiting health facility)

-   FGD guidelines (e.g. with FCHVs, representatives from mothers groups etc.)

6.  Entry to the community, Rapport Building, Social Mapping

7.  Data collection

8.  Data entry and processing: Data validation, Data sorting and sequencing, summarizing, coding, aggregation, computing etc.

9.  Data analysis and Interpretation: Descriptive and Inferential analysis, in community diagnosis we usually perform descriptive analysis (frequency, ratio, proportions, percent, etc.) Data can be displayed in the form of sentences, tables, graphs, charts.

10. Need identification: Determining observed needs and felt needs, and then finalizing the real needs of the community and ultimately identifying the necessary measures to solve them.

11. Prioritizing needs with community people:

Not all needs can be met. There are certain to be used to prioritize the health needs of the community, which are listed as follows:

-  Equity
- Burden of disease (Magnitude, severity)
- Cost effectiveness
- Community interest
- Existing capacity
- National Priority
- Sustainability
- Time for evaluation

Need prioritization score table

Needs	Magnitude	Severity	Cost effectiveness	Community interest	National priority	Feasibility	Sustainability	Time for evaluation	Total score
1
2
3
…..

12. Conducting Micro-Health Project and evaluation

13. Dissemination: Community presentations, final report sharing to community and concerned authorities

14. Follow up

It is important to realize that Community Diagnosis is not a one-off project, but is part of a dynamic process leading to health promotion in the community. Therefore community diagnosis should be conducted at regular intervals to allow the health status of the community to be continuously improved.

Differences between Clinical diagnosis and Community diagnosis

Important of Community Diagnosis

1. It provides an overall picture of the local community and the residents’ concerns, and helps to determine existing health problems of community
2. It helps to determine the magnitude of health problems, their quantity & limitations
3. It helps to identify factors that affect the health of a population and determine the availability of resources within the community to adequately address these factors
4. It help to make decision on relation between existing health problems & factors affecting them
5. It guides for fixing priorities for solving problems
6. It provides guidelines for collection of baseline information or data regarding the program.
7. It gives feedback about the implementation, monitoring, surveillance and supervision of the program.
8. It helps to study the effectiveness of health service of community and its effect.
9. It helps to make systematic planning and implementation program by identifying the felt need & observed need of the community.
10. It helps to mobilize the public participation for improving community health. 
11. It acts as a data reference for the community under study
12. It suggests priority areas for intervention and the feasible solutions
13. It indicates the resource allocation and the direction of work plans
14. It creates opportunities for intersectoral collaboration and media involvement
15. It forms basis of setting indicators for community health evaluation

Introduction to Community Diagnosis

Community

The term community has two distinct independent meanings:

• Community can refer to a usually small, social unit of any size that shares common values. The term can also refer to the national community or international community,
• In biology, a community is a group of interacting living organisms sharing a populated environment.
• In human communities, intent, belief, resources, preferences, needs, risks, and a number of other conditions may be present and common, affecting the identity of the participants and their degree of cohesiveness.

What is community diagnosis?

According to WHO definition, it is “a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action”.

Community diagnosis generally refers to the identification and quantification of health problems in a community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those at risk or those in need of health care.

Community Health Diagnosis is the means of examining aggregate and social statistics in addition to the knowledge of the local situation, in order to determine the health needs of the community.

Concept of Community Diagnosis

Community health assessment/diagnosis is both a process and a product.

As a process:

1. Gathering and interpreting information
2. Prioritizing needs and developing strategies
3. Conducting and evaluating the MHP
4. Preparing the further strategies

As a product:

1. Community diagnosis report
2. Further/future intervention plans

The community diagnosis is a theoretical framework for prevention in the health sector. Basically, the concept of community diagnosis deals with a process having distinct levels:

1. Descriptive,
2. Analytical, and
3. Action programs.

The first two levels of information form the basis for the community diagnosis process which is then followed by community health action.

Purpose of Community Diagnosis

• Analyze the health status of the community
• Evaluate the health resources, services, and systems of care within the community
• Assess attitudes toward community health services and issues
• Identify priorities, establish goals, and determine courses of action to improve the health status of the community
• Establish an epidemiologic baseline for measuring improvement over time.

Components of Community Diagnosis  

• A description of the demographics of the population
• Sociocultural and behavioral aspects of the community
• A general description of health problems by different strata of the population
• Availability of health resources in the community and the pattern of delivery and utilization
• Non-health resources and their role in future improvement
• Knowledge, attitude & practice of the population in respect to health related activities.

Constraints of Community Diagnosis

• Community diagnosis is based on community participation and information is gathered based on their responses which may lead to biases and inappropriate action plans. 
• Conflicts while priority setting between felt need & observed need to decide the real health needs of the community. 
• Legal hurdles as the investigations are mainly community-based. 
• Generalizability: We cannot generalize the findings and the way we implement the action plans based on diagnosis perform in a community. People belong to different communities with their respective health beliefs and practices.

Survey

Making a single observation to measure and record something is a survey. Surveys are usually rapid, cross-sectional and mostly descriptive, one-shot (Usually not continuous) study. Survey is usually reactive (happen when the problems occur). Survey doesn’t usually cover the whole population, usually sampling is done. Survey incurs onetime cost. Survey might not be necessarily linked to public health system, recording and reporting to district health authority might not be mandatory. Mostly survey is done to solve a problem at particular point of time. Survey can serve as the basis for further studies. Survey can be done on any topic or area of interest, usually acute health problems. Community diagnosis programs (academic) are good examples of survey. There are no definite approaches of survey, they are conducted as per need, mostly involve field investigations.