Lesson 2: Community

INTRODUCTION
Community Health Nurses work in communities therefore, the need to be knowledgeable about the people and where they live.

LEARNING OUTCOMES/SPECIFIC OBJECTIVES
By the end of the lesson, the student should be able to :
 * Define community.
 * Describe the different types of community.
 * Differentiate between urban and rural communities.
 * Outline community profile.

DEFINITION OF COMMUNITY

 * A place or geographical area where a group of people live and share common interest and aspiration and have social network of relationship at the local level


 * A group of people with well defined demographic characteristics and power structure.


 * People who do not live in the same neighbourhood but share common characteristics in terms of goals.

TYPES OF COMMUNITIES
It refers to people residing in a population of 2500 or less, they share the same needs, have common ealth problems, have the same culture, beliefs, they are more united and have the informal way of interaction.
 * RURAL COMMUNITY

Has a population about 500 or more They have different ethnic groups They have different ideas, beliefs, taboos, culture etc. Their needs and problems could be the same or different. They are old established settlement. They have common identifiable traits. Ethnic groupings such as clans, families, beliefs, culture, division in terms of religion, employment, etc. could be found. Important natural bonds such as common leadership, language, traditions and customs hold members of this type of community together. These could provide useful criteria for segmenting such communities into recognisable and practical units to facilitate mobilisation for sustained development activities. On the other the hand the beliefs and customs of some of such traditional  communities could hinder the work of health workers as such beliefs and customary practices may conflict with conventionally acceptable health practices. Most rural towns and villages in Ghana typify traditional communities. All community mobilisers must note the varying influences of urbanisation and modernisation eroding the traditional community values and norms of rural communities. In this respect the concepts of solidarity and   neighbourhood community have to be understood.
 * URBAN COMMUNITY
 * TRADITIONAL COMMUNITY

In the Solidarity Community, people are seen to be living in a common territory because of common heritage such as nationality, ethnicity, religion or language. Since they often define themselves as belonging to that group and fell emotionally loyal to it, the possibility of their working as a community to promote their own health and well-being is high, on the other hand their objection to a type of health information because it contradicts their belief systems could hinder the promotion of health programs. Examples of these communities are the Ewe community of Kumasi – Anloga, the Dagomba community in Nima, Accra, the religious settlement such as Yordan nu near Vakpo in the Volta Region and the Zongo communities dotted all over the country.
 * SOLIDARITY COMMUNITY

Another territorially bound conception of community, which could be recognised and used to promote community mobilisation, is the Neighbourhood Community. This develops as people live in area together for a period of time and in the process develop familiarity out of which strong loyalty may grow. Examples of such communities are the Workers Estates, Civil Servants Bungalows, SSNIT Flats, Nurses Quarters etc.
 * NEIGHBOURHOOD COMMUNITY

Neighbourhood integration may however not be totally based on loyalty and personalities but also on shared interests and common problems such as unsanitary surroundings, poor water and sanitation facilities, and outbreaks of common illness which may call for attention from all.

Neighbourhood communities when properly identified and recognised through a problem focus can therefore effectively serve as a manageable unit into which people could be organised for effective and sustainable participation in health services delivery.

KEY FEATURES OF A COMMUNITY
This resource is important to health planners and service providers to improve coverage, content, relevance and quality of programs.
 * Political Structure: communities have their own structures around which political activities are organised. It is extremely important to know and understand these structures and how they function when entering the communities with health related activities.
 * Traditional Political Structure: identify position, roles and responsibilities of the paramount chief, divisional chiefs, elders, spiritual leaders etc.


 * Formal political structure: to enter a community, it is important to identify formal and governmental structures that exist in the community. Some of these structures include the office of the District Chief Executive The District Assembly, Unit Committees Village And Town Development Committees Village Health Committees. TBA etc.


 * Family Organisation: two family systems exit in Ghana patrilineal and matrilineal . most families are extended families although the nuclear family system is gradual taking form in the urban communities e.g. In the patrilineal men take decision therefore the need to involve them in program.

The modern health institution include both pubic and private hospitals, health centres and clinics. The traditional structures also include: traditional healers, TBA etc.
 * Health institutions in the community: in every community there are various health institutions that provide health care for community members. It is important to note the existence of both modern and traditional health institution in the community.


 * Physical Characteristics Of The Community: accessibility of various sections of the community will depend on how rocky, mountainous, water logged the terrain is, availability of relevant infrastructure in the community. Knowledge about the road net work ,transport.


 * Religious groups: Christianity, Islam, traditional identify and work with them.


 * Cultural institutions: you need to know about local market days, this can be used for effective dissemination. Identify cultural characteristics of the community such as beliefs, customs, norms, taboos and habits etc.

COMMUNITY PROFILE
The community profile is a handy documentation or outline of the main characteristics of the community so identified for the application CHPS. It is a document that informs the health worker of what the community is, what it has what it has not, in terms of health and other social structures for health promotion in the community.


 * The main features described in a typical community profile are listed below.
 * Name of community
 * Name of zone in which community is located
 * Name of sub-district in which community is located
 * Name of villages/settlements making up the community
 * Brief definition of landscape and vegetation
 * Main customs and beliefs of the people
 * Predominant religious groupings
 * Economic activities – sources of income
 * Economic facilities – markets, shops etc.
 * Forms of transportation
 * Forms of communication
 * Water facilities
 * Sanitation facilities
 * Housing – nature and pattern of housing
 * Schools and other educational facilities
 * Health facilities – hospitals, clinics, health posts, chemists shops, traditional healers and TBA’s home etc
 * Disease patterns:
 * Most common causes of illness
 * Most frequently diagnosed diseases
 * Special and unusual health problems


 * Sickness and health behaviour:
 * Who people see for health when sick
 * What people do to prevent illness
 * What role traditional healers and TBA’s play in health delivery.

COMMUNITY POPULATION REGISTER
This is a document that provides a record of the characteristics of individual members of the community. It provides a summary of the basic demographic information about the community.


 * USES:
 * 1) The community population register is a tool for effective planning of health services.
 * 2) It helps workers to keep track of birth and deaths in the community.
 * 3) It is used to assess migration in and out of the community.
 * 4) It helps workers to quickly determine the immunization status of children and women.
 * 5) It helps health workers to determine the contraceptive status of women and men.
 * 6) IT provides information on the following;
 * 7) Household Identification Particulars ;
 * 8) Particulars of Household members;
 * 9) Particulars of birth and Nationality ;
 * 10) Immunization Records
 * 11) Disability Records
 * 12) Migration Records
 * 13) Literacy Records;
 * 14) Occupation; and Particulars of death

TESTS AND QUIZZES

 * Explain community to the first year student.
 * Differentiate between a traditional solidarity communities
 * What is a community profile and what are its uses.
 * What is a community register.