COMMUNITY DIAGNOSIS

Introduction
Key concepts

Community
A cluster of people with at least common characteristics geographical location, occupation,
ethnicity, housing condition etc.

A group of people with a common characteristic or interest living together within a larger society

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”. The practical relevance of community diagnosis in HCP
includes:

Community diagnosis
Community diagnosis is the means of identifying in consultation with the community the
diseases or health problems that are important and those which should be given priority in the
activities of health workers.
Purposes of community diagnosis:

a) Identification and quantification of health problem

b) Identification of those who at risk
c) Identification of community needs and problems
d) Determine available resources
e) Set priorities for planning
Community Diagnosis is done using a tool called "Health Indicators" which are the variables
used for the assessment of community health. Indicators must be: valid, reliable, sensitive,
specific, feasible, and relevant.

Health indicators can be classified as:

• Mortality indicators
• Morbidity indicators
• Disability rates
• Nutritional status indicators
• Healthcare 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
Community analysis: Community analysis is the process of examining data to define needs
strengths, barriers, opportunities, readiness, and resources. The product of analysis is the
“community profile.”
WAYS OF CARRYING OUT COMMUNITY DIAGNOSIS

Observations

This is when you go to a place, it can be a health unit or community to see how things are done
or how things are happening, observe and listen to what people say. Observation should be done
using a checklist
Interviewing

Interview is talking to people and asking the questions on a particular issues e.g. on use of a pit
latrine, the use of a health unit on immunization. You use questioners to interview people. At
times you can talk to people informally and still get some information Surveillance. This is
keeping close watch over something.

IMPORTANCE OF COMMUNITY DIAGNOSIS

a) It helps to identify health problems in the community and health needs.

b) To determine how well a health facility is dealing with the health problem
c) To identify areas which need support supervision
d) Determine the utilization of the health service provided by the health unit
e) It is a pre-requisite of learning implementing and evaluation of successful community
based health problems
f) It fosters community participation
g) It helps to enable the community to prioritize their problems before implementing
h) It is an opportunity for outsiders like health workers to learn about the community.
i) It helps to increase community’s level of awareness about the prevailing/ factors that
Affect their health and general development

STEPS FOR COMMUNITY DIAGNOSIS

Before carrying out community diagnosis, meet and talk with community leaders to get their
own opinions about the community.
The following are steps followed when conducting community diagnosis
1. Identify the need for community diagnosis
Identification of needs as perceived by the community is a useful process of assessing
the priority of values of the people.
2. Identify information to be collected e.g. information on population like age, sex, tribe
etc.
• Birth in previous month or years

• Deaths in the first year, or month etc.

• Immunization coverage

• Sanitation condition and nutritional status

 This information may be collected from household, health unit, local authority, women’s
clubs, and youth groups.

3. Identify the source of data

The best information can be got from the community, the unit and the health workers.

4. Identify methods of collecting data, the following methods can be used:

(a) Observation: This is by observing events, procedures, and listening to whatever

they are telling you or how things are being done. It’s cheap and it can be done
using a checklist.

Disadvantages of observation

- It’s time wastage

- Respondancy may not give up to date information

(b) Interview: This is asking questions verbally on a particular issue e.g. pit latrines,
drying racks and immunization use of health units and then receiving answers
with a systemic laid down procedure. A questionnaire is used to interview to
people at times you can talk to people and still get some information.

(c) Group discussion: This is gathering information from a targeted group of people
by exchanging ideas and views on concerned issues with the use of a guide (tool)
it is cheap and it promotes interpersonal relationship.

(5)Key information and interview: These are people in the community e.g. local leaders
(LC’s) they are interviewed on health related matters because they have enough
information concerning the community.
(6)Record view (vital statistics): This is by use of previous information which was written
and kept
 Advantages of record review

- It’s easy to be obtained since it was stored.

Disadvantages of record review

- Mis-recording can fail you, some information may not be

complete

(7) Develop tools, instruments for collecting data: The types of data collection tools
include check lists, questionnaires village record books; parish registers guides like focus
group on key information guide.

(8) Carry out community diagnosis: Prepare together all the necessary requirements
needed to be used in exercises e.g. materials, manpower, pens and paper, and a location
of different places.

(9)Data Analysis and interpretation: Analysis refers to arranging and grouping data
according to variables of interest. This will include the following steps,

- Sort out the checklist from questionnaires

- Sort out questionnaires with the same required data and put them
together this will also apply to the check list
- Discuss on how you may want to draw up some rough forms in
which to enter data or use a blank questionnaire or check on each
type.
- Tabulate the results from each set of questionnaire or check list,
total up the results of all the observation.
- Decide on how to present information, you could put information
in tables, graphs and pie- charts.
 (10) Write a report: The report should be presented in a simple way and as specific as
possible in terms of what, who, how many, how much etc.
- Information should be able to stimulate discussion and decisions
- Present by giving positive and negative proposals and this should
be emphasized in order to create a change.

(11) Give feedback: It’s always important to give a feedback this helps the community to
know their weakness where they are doing well and areas to be improved.

STAGES OF COMMUNITY DIAGNOSIS

The process of community diagnosis involves four stages:

1. Initiation
2. Data collection and analysis
3. Diagnosis
4. Dissemination

Initiation
In order to initiate a community diagnosis project, a dedicated committee or working group
should be set up to manage and coordinate the project. The committee should involve relevant
parties such as government departments, health professionals and non-governmental
organisations.
At an early stage, it is important to identify the available budget and resources to determine the
scope of the diagnosis. Some of the common areas to be studied may include health status,
lifestyles, living conditions, socioeconomic conditions, physical and social infrastructure,
inequalities, as well as public health services and policies.
Once the scope is defined, a working schedule to conduct the community diagnosis, production
and dissemination of report should be set.
2. Data collection and analysis
The project should collect both quantitative and qualitative data. Moreover, Population Census
and statistical data e.g. population size, sex and age structure, medical services, public health,
social services, education, housing, public security and transportation, etc. can provide
background of the district. As for the community data, it can be collected by conducting surveys
through self-administered questionnaires, face to face interviews, focus groups and telephone
interviews.
In order to ensure reliability of the findings, an experienced organisation such as an academic
institute can be employed for conducting the study. The sampling method should be carefully
designed and the sample size should be large enough to provide sufficient data to draw reliable
conclusions. Therefore, study results derived can truly review the local community.
Collected data can then be analysed and interpreted by experts. Here are some practical tips on
data analysis and presentation:
- statistical information is best presented as rates or ratios for comparison
- trends and projections are useful for monitoring changes over a time period for future planning
- local district data can be compared with other districts or the whole population
- graphical presentation is preferred for easy understanding

Diagnosis
Diagnosis of the community is reached from conclusions drawn from the data analysis. It should
preferably comprise three areas:
- health status of the community
- determinants of health in the community
- potential for healthy city development

4. Dissemination
The production of the community diagnosis report is not an end in itself, efforts should be put
into communication to ensure that targeted actions are taken. The target audience for the
community diagnosis includes policy-makers, health professionals and the general public in the
community.
The report can be disseminated through the following channels:
- presentations at meetings of the health boards and committees, or forums organised for
voluntary organisations, local community groups and the general public
- press release
- thematic events (such as health fairs and other health promotion programmes)