HANDOUT FOR THE POSTER P PRESENTATION FOR WORLD CONFERENCE ON HEALTH PROMOTION BY SUPATTRA SRIVANICHAKORN, TASSANEE YANA, ET AL. Analyzing of selective tools and approaches for community health needs assessment

Rationale Community health development is about making changes by developing a new program (or modifying an existing one), bringing about a change in policy, or adjusting a practice related to the community’s mission needs assessment. Community health development are concerned with broader political and social context, national policies on decentralization, communities’ characteristics, available resources and problems encountered within the communities. Numbers of communities are experienced with health and social development by different tools and approaches regarding to the issues, leadership and communities’ decisions and contexts. Stills, questions on practical tools, utilized model, and measurement for community health needs assessment and empowerment. However, this project will focus at the assessment aspect.

Objectives General To analyze tools and approaches for community health needs assessment. Specific To revisit current knowledge on community health development focusing on assessment aspects from the literature review and experts’ opinions. To identify various existing practical tools, utilized model for community health needs assessment and empowerment. To synthesis the strengths and weak points of selected tools for community health assessment under specific model of use. To propose the set of indicators to measure empowered community.

Criteria to select tools for community health assessment for the project Characteristics Flexible and response to the community health assessment in wide aspects of health as community well-being. Applied by various users in community, not only health professions but community leaders and local authorities at the sub-district levels. Original resource persons and references are available and accept for the project contributions. Enable for community participation and promote community empowerment.

Study design and activities undertaken ActivitiesResults 1.Review literature on tools for community health assessments focusing at project reports, lessons learned and synthesis papers from various organizations. Inputs for analysis 2.In-depth interview with semi structure interview questions with experienced persons and experts on community health needs assessment. 1.Mr. Narej Songkrausuk 2.Dr. Amorn Nonthasuth 3. Assistant. Prof. Bunchorn Kaewsong Experts’ opinions as inputs for analysis

Activities undertaken ActivitiesResults 3.Organise academic forums among researchers of community research clusters on various tools and community health assessment and empowerment Learning network, peer review Academic inputs for analysis 4.Workshop: Knowledge management on practical tools, specific methods and lessons learned among practitioners and involved community members in the fields. Learning network Operational inputs for analysis 5. Meeting: Present and disseminate the technical knowledge from the study to involved stakeholders Complementary to project completion

Research outputs Technical knowledge 1. Analysis of selective tools: Strategic Route Map(SRM), community based research and social mapping: TRF)/ (Thai Health), integrated tool and approach through participatory actions 2. Framework of analysis: principle, targeted users, practical methods of utilization, strengths and weaknesses, lessons learned, facilitating contexts for the effectiveness of using such tools. 3. Set of indicators to measure empowered community

Scope of analysis of selective tools STRATEGIC ROUTE MAP(SRM) COMMUNITY BASED RESEARCH AND SOCIAL MAPPING INTEGRATED TOOL ADOPTED WITH PARTICIPATORY ACTIONS CONTENTS: principle, targeted users, practical methods of utilization, outputs LESSONS LEARNED: strengths, weaknesses or limitations, facilitating conditions for effective used CONTENTS: principle, targeted users, practical methods of utilization, outputs LESSONS LEARNED: strengths, weaknesses or limitations, facilitating conditions for effective used CONTENTS: principle, targeted users, practical methods of utilization, outputs LESSONS LEARNED: strengths, weaknesses or limitations, facilitating conditions for effective used

Research findings: Analysis of selective tools(1) Strategic Route Map(SRM) Principle: new strategic management tool for health development: shifting concept from providing services to problem resolution and promote sustainable community self reliance Targeted users: mostly used by health professionals with active participation of community and local authorities, endorsed through MOPH under THPH development policy, and often used together with community health funds(NHSO) Practical methods of utilization: 7 key steps on 1) situation analysis; 2) statement on expected outputs-outcome; 3) strategic planning and review; 4) strategic operational route map development; 5) definition/targeting/ indicators/ innovations/ community measures; 6)operational plan; and 7) actions and follow up Outputs: community’s challenging agenda, learning tool and involvement for community measures and public policy development, reference framework for various communities’ decision makings on health interventions and improvement

Research findings: Analysis of selective tools(1) Lessons learned Strengths: raise awareness for community’s concerns and participation promote individual and group learning through action concept applicable for various contexts, contents and phase of the development designed by communities Limitations: require community’s positioning and involvement: necessary baseline context, update information, critical analysis and team management Facilitating conditions for effective used: leading role model either individual or community groups previous success stories and level of active participation capacity for community self assessment, change management

Research findings: Analysis of selective tools(2) Community based research and social mapping (TRF)/(Thai Health) Principle: a research and development tool for participatory community assessment, problem solving, and leading to empowerment Targeted users: originally for community groups and organizations, then expanded for other sectors and widely adopted in local authorities with technically and financially supported by TRF and Thai Health Practical methods of utilization: participatory social mapping(identify physical environment and natural resources, historical, political and economical context, kinship and social network, health problems and available services both formal and informal) and building learning community networks for further community development Outputs: community datasets, collective leadership, shifting balance of community leaders and members, body of knowledge and proposes of community actions to changes

Research findings: Analysis of selective tools(2) Lessons learned Strengths: acceptance of researchers as an external assessment tool for identify community positioning and research comprehensive tool, focused by community rather than external persons or organizations evidence based decision making Limitations: clarification of community based research: need ownership on community proposal, active participation and interventions systematic design of social mapping may cause imbalance and vague information, time and person consumption aware of bias and experience of community researchers Facilitating conditions for effective used: potential community groups with different sources of information and approaches(secondary information review, observation, interview, focus group discussion, etc.) appropriate(external) technical facilitators meaningful information not only study, valued and used by community members not funding agencies

Research findings: Analysis of selective tools(3) Integrated tools adopted with participatory actions Principle: user as a tool, focused at knowing self-learner concept in order to understand community contexts of power, cultural, historical, financially relations among community members. No design of fixed template. Targeted users: adopted in health professionals and community organization network, especially in northern region. Practical methods of utilization: observatory and participatory assessment and action-reflection approaches on 1) community life cycle; 2) historical analysis; 3) relations of community compositions and factors; and 4) analysis of cost(measurable) and value(immeasurable) in community Outputs: creation of continuous self learning and community review, experimental actions on integrated tools, promote capacity building, knowledge generation through actions

Research findings: Analysis of selective tools(2) Lessons learned Strengths: self learning process, which embedded in community and enhance community potentials high flexibility with challenging contexts Limitations: limited dissemination due to variation of context based, learning contract(inner side related), approaches, and experience of users need facilitators for continuous learning on appropriate tools’ applications in certain community Facilitating conditions for effective used: facilitators’ abilities to access community’s perceptions, thoughts and surrounding environment. multi-disciplinary adoption, constructive and effective communicator, and ability for systematic thinking

Research findings: Synthesis on selective tools Tools Issues Strategic Route Map Community Based Research and Social Mapping Integrated tools Organizational endorsement, adoption and dissemination /- Level of community assessment contents in toolbox +++++(TRF) ++++(Thai Health) ++ Clarification on tool application by stakeholders at the community level Enhancement of active community participation with proactive change agents ++++ Flexibility for various contents of community development Visibility (for external view) of the community outputs/ outcomes highest engagement.+ minimal engagement, +/- uncertain, voluntary engagement

Research findings: Set of indicators to measure empowered community 1. Concerning the difference of meaning and definitions varied to whose perceptions, concepts of empowerment, and community contexts. 2. However, community members’ definitions on empowered community count. 3. Set of indicators, which reflect empowered community could be categorized into 3 groups: Mechanisms Contextual facilitating factors Processes

Research findings: Set of indicators to measure empowered community 4. Proposed indicators, which reflect empowered community are 4.1 Availability of either formal or informal active groups in community. 4.2 Existing of flexible learning processes in community; internal side, external settings and apply to their own community development or other communities. 4.3 Concerns on community information and utilization management. Community information should composed of

Research findings: Set of indicators to measure empowered community Community settlement: historical, socioeconomic, ecological, cultural background and current situation in community. Physical infrastructures, natural resources and environment. Power relations in community(individual, family, group of people, organizations, networks). Potentials and functions of leaders, role models, important persons, managerial persons in community. External and internal influencing persons, involved networks, units and organizations toward community development. Disadvantage groups, people in needs of health services and social welfare in community.

Research findings: Set of indicators to measure empowered community 5. Changes in terms of outputs and/or outcome in community that reflect community self management by existing mechanisms within community. 6. Sustainability in community can be preliminary seen by continuous activities by various community groups. strong commitment among community members. initiative community problems solving projects, measures, and healthy public policy. growing trends or numbers of active persons/groups and improved mechanisms in community.