Community Organizing Participatory Action Research

(COPAR)
Definitions of COPAR
A social development approach that aims to
transform the apathetic, individualistic and voiceless
poor into dynamic, participatory and politically
responsive community.
A collective, participatory, transformative, liberative,
sustained and systematic process of building
peoples organizations by mobilizing and enhancing
the capabilities and resources of the people for the
resolution of their issues and concerns towards
effecting change in their existing oppressive and
exploitative conditions (1994 National Rural
Conference)
A process by which a community identifies its needs
and objectives, develops confidence to take action
in respect to them and in doing so, extends and
develops cooperative and collaborative attitudes
and practices in the community (Ross 1967)
A continuous and sustained process of educating
the people to understand and develop their critical
awareness of their existing condition, working with
the people collectively and efficiently on their
immediate and long-term problems, and mobilizing
the people to develop their capability and readiness
to respond and take action on their immediate
needs towards solving their long-term problems
(CO: A manual of experience, PCPD)
Importance of COPAR
1. COPAR is an important tool for community
development and people empowerment as this
helps the community workers to generate
community participation in development activities.
2. COPAR prepares people/clients to eventually take
over the management of a development programs
in the future.
3. COPAR maximizes community participation and
involvement; community resources are mobilized for
community services.
Principles of COPAR
1. People, especially the most oppressed, exploited
and deprived sectors are open to change, have the
capacity to change and are able to bring about
change.
2. COPAR should be based on the interest of the
poorest sectors of society
3. COPAR should lead to a self-reliant community and
society.
COPAR Process
A progressive cycle of action-reflection
action which begins with small, local and concrete
issues identified by the people and the evaluation

and the reflection of and on the action taken by

them.
Consciousness through experimental learning
central to the COPAR process because it places
emphasis on learning that emerges from concrete
action and which enriches succeeding action.
COPAR is participatory and mass-based because it
is primarily directed towards and biased in favor of
the poor, the powerless and oppressed.
COPAR is group-centered and not leader-oriented.
Leaders are identified, emerge and are tested
through action rather than appointed or selected by
some external force or entity.

Critical Steps in COPAR

1. Integration
2. Social Investigation
3. Tentative program planning
4. Groundwork
5. Meeting
6. Role Play
7. Mobilization or action
8. Evaluation
9. Reflection
10. Organization
4 Phases of COPAR
1. Pre-Entry Phase
Is the intial phase of the organizing process where the
community organizer looks for communities to serve and
help. Acitivities include:
Preparation of the Institution
Train faculty and students in COPAR.
Formulate plans for institutionalizing COPAR.
Revise/enrich curriculum and immersion program.
Coordinate participants of other departments.
Site Selection
Initial networking with local government.
Conduct preliminary special investigation.
Make long/short list of potential communities.
Do ocular survey of listed communities.
Criteria for Initial Site Selection
Must have a population of 100-200 families.
Economically depressed. No strong resistance from
the community.
No serious peace and order problem.
No similar group or organization holding the same
program.
Identifying Potential Municipalities
Make long/short list of potential municipalities
Identifying Potential Community
Do the same process as in selecting municipality.
Consult key informants and residents.

Coordinate with local government and NGOs for

future activities.

Choosing Final Community

Conduct informal interviews with community
residents and key informants.
Determine the need of the program in the
community.
Take note of political development.
Develop community profiles for secondary data.
Develop survey tools.
Pay courtesy call to community leaders.
Choose foster families based on guidelines
Identifying Host Family
House is strategically located in the community.
Should not belong to the rich segment.
Respected by both formal and informal leaders.
Neighbors are not hesitant to enter the house.
No member of the host family should be moving
out in the community.
2. Entry Phase
sometimes called the social preparation phase. Is crucial in
determining which strategies for organizing would suit the
chosen community. Success of the activities depend on how
much the community organizers has integrated with the
commuity.
Guidelines for Entry
Recognize the role of local authorities by paying
them visits to inform their presence and activities.
Her appearance, speech, behavior and lifestyle
should be in keeping with those of the community
residents without disregard of their being role
model.
Avoid raising the consciousness of the community
residents; adopt a low-key profile.
Activities in the Entry Phase

Integration. Establishing rapport with the people in

continuing effort to imbibe community life.
o living with the community
o seek out to converse with people where they
usually congregate
o lend a hand in household chores
o avoid gambling and drinking

Deepening social investigation/community study

o verification and enrichment of data collected from
initial survey
o conduct baseline survey by students, results
relayed through community assembly
Core Group Formation

Leader spotting through sociogram.

Key Persons. Approached by most people
Opinion Leader. Approached by key persons
Isolates. Never or hardly consulted

3. Organization-building Phase
Entails the formation of more formal structure and the
inclusion of more formal procedure of planning,
implementing, and evaluating community-wise activities. It is
at this phase where the organized leaders or groups are
being given training (formal, informal, OJT) to develop their
style in managing their own concerns/programs.
Key Activities
Community Health Organization (CHO)
o preparation of legal requirements
o guidelines in the organization of the CHO by the
core group
o election of officers
Research Team Committee
Planning Committee
Health Committee Organization
Others
Formation of by-laws by the CHO
4. Sustenance and Strengthening Phase
Occurs when the community organization has already been
established and the community members are already actively
participating in community-wide undertakings. At this point,
the different committees setup in the organization-building
phase are already expected to be functioning by way of
planning, implementing and evaluating their own programs,
with the overall guidance from the community-wide
organization.
Key Activities
Training of CHO for monitoring and implementing
of community health program.
Identification of secondary leaders.
Linkaging and networking.
Conduct of mobilization on health and development
concerns.
Implementation of livelihood projects.
Biostatistics

DEMOGRAPHY - study of population size,

composition and spatial distribution as affected by
births, deaths and migration.
Sources: Census complete enumeration of the
population

2 Ways of Assigning People

1. De Jure - People were assigned to the place where
assigned to the place they usually live regardless of
where they are at the time of census.
2. De Facto - People were assigned to the place where
they are physically present at are at the time of
census regardless, of their usual place of residence.
Components
1. Population size

2.

Population composition
o Age Distribution
o Sex Ratio
o Population Pyramid
o Median age - age below which 50% of the
population falls and above which 50% of
the population falls. The lower the median
age, the younger the population (high
fertility, high death rates).
o Age Dependency Ratio - used as an index
of age-induced economic drain on human
resources
o Other characteristics:
occupational groups
economic groups
educational attainment
ethnic group

Population Distribution
Urban-Rural - shows the proportion of
people living in urban compared to the
rural areas
Crowding Index - indicates the ease by
which a communicable disease can be
transmitted from 1 host to another
susceptible host.
Population Density - determines
congestion of the place

Vital Statistics

The application of statistical measures to vital events

(births, deaths and common illnesses) that is utilized
to gauge the levels of health, illness and health
services of a community.

Types of Vital Statistics

Fertility Rate or Birth Rate - the ratio of live births in an
area to the population of that area; expressed per 1000
population per year
1. Crude Birth Rate
Total # of livebirths in a given calendar year
X 1000
Estimated population as of July 1 of the same given year
2. General Fertility Rate
Total # of livebirths in a given calendar year
X 1000
Total number of reproductive age
Mortality Rate or Death Rate = The ratio of total deaths to
total population in a specified community or area over a
specified period of time. The death rate is often expressed as
the number of deaths per 1,000 of the population per year.
Also called fatality rate.
1. Crude Death Rate
_Total # of death in a given calendar year_

X 1000
Estimated population as of July 1 of the same calendar year
2. Infant Mortality Rate
Total # of death below 1 yr in a given calendar year
X 1000
Estimated population as of July 1 of the same calendar
year
3. Maternal Mortality Rate
Total # of death among all maternal cases in a given
calendar year
X 1000
Estimated population as of July 1 of the same
calendar year
Morbidity Rate = The rate of incidence of a disease; the
relative incidence of a particular disease
1. Prevalence Rate
Total # of new & old cases in a given calendar year
X 100
Estimated population as of July 1 of the same calendar
year
2. Incidence Rate
Total # of new cases in a given calendar year_
X 100
Estimated population as of July 1 of the same calendar
year
3. Attack Rate
Total # of person who are exposed to the disease
X 100
Estimated population as of July 1 of the same calendar
year
Epidemiology
the study of distribution of disease or physiologic
condition among human population s and the
factors affecting such distribution
the study of the occurrence and distribution of
health conditions such as disease, death, deformities
or disabilities on human populations
1. Patterns of disease occurrence
Epidemic
A situation when there is a high incidence of new
cases of a specific disease in excess of the expected.
when the proportion of the susceptible are high
compared to the proportion of the immunes
Epidemic potential
an area becomes vulnerable to a disease upsurge
due to causal factors such as climatic changes,
ecologic changes, or socio-economic changes
Endemic

habitual presence of a disease in a given geographic

location accounting for the low number of both
immunes and susceptibles.E.g. Malaria is a disease
endemic at Palawan.
The causative factor of the disease is constantly
available or present to the area.

9.

4.
5.

Sporadic
disease occurs every now and then affecting only a
small number of people relative to the total
population
intermittent

6.

Pandemic
global occurrence of a disease

7.

Steps in Epidemiological Investigation:

1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the
community
4. Correlate all data obtained
DEPARTMENT OF HEALTH (DOH)
Vision
Health for all Filipinos
Mission

Ensure accessibility & quality of health care to

improve the quality of life of all Filipinos, especially
the poor.

National Objectives
1. Improve the general health status of the population
(reduce infant mortality rate, reduce child morality
rate, reduce maternal mortality rate, reduce total
fertility rate, increase life expectancy & the quality of
life years).
2. Reduce morbidity, mortality, disability &
complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism, Sexually
Transmitted Diseases, Hepatitis B, Accident &
Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma
& Chronic Obstructive Pulmonary Diseases,
Nephritis & Chronic Kidney Diseases, Mental
Disorders, Protein Energy Malnutrition, and Iron
Deficiency Anemia & Obesity.
3. Eliminate the ff. diseases as public health problems:
1. Schistosomiasis
2. Malaria
3. Filariasis
4. Leprosy
5. Rabies
6. Measles
7. Tetanus
8. Diphtheria & Pertussis

Vitamin A Deficiency & Iodine Deficiency

Disorders
Eradicate Poliomyelitis
Promote healthy lifestyle through healthy diet &
nutrition, physical activity & fitness, personal
hygiene, mental health & less stressful life & prevent
violent & risk-taking behaviors.
Promote the health & nutrition of families & special
populations through child, adolescent & youth,
adult health, womens health, health of older
persons, health of indigenous people, health of
migrant workers and health of different disabled
persons and of the rural & urban poor.
Promote environmental health and sustainable
development through the promotion and
maintenance of healthy homes, schools, workplaces,
establishments and communities towns and cities.

Basic Principles to Achieve Improvement in Health

1. Universal access to basic health services must be
ensured.
2. The health and nutrition of vulnerable groups must
be prioritized.
3. The epidemiological shift from infection to
degenerative diseases must be managed.
4. The performance of the health sector must be
enhanced.
Primary Strategies to Achieve Goals
1. Increasing investment for Primary Health Care.
2. Development of national standards and objectives
for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.
Millennium Development Goals (MDGs)
The Millennium Development Goals (MDGs) are
eight international development goals that were officially
established following the Millennium Summit of the United
Nations in 2000, following the adoption of the United
Nations Millennium Declaration. All 193 United
Nations member states and at least 23 international
organizations have agreed to achieve these goals by the year
2015. The goals are:
1. Eradicating extreme poverty and hunger,
2. Achieving universal primary education,
3. Promoting gender
equality and empowering women,
4. Reducing child mortality rates,
5. Improving maternal health,
6. Combating HIV/AIDS, malaria, and other diseases,
7. Ensuring environmental sustainability, and
8. Developing a global partnership for development.

DOH PROGRAMS
BOTIKA NG BARANGAY (BnB)
Botika ng Barangay (BnB) - refers to a drug outlet
managed by a legitimate community organization (CO) /
non-government organization (NGO) and/or the Local
Government Unit (LGU), with a trained operator and a
supervising pharmacist specifically established in accordance
with this Order. The BnB outlet should be initially identified,
evaluated and selected by the concerned Center for Health
Development (CHD), approved by the PHARMA 50 Project
Management Unit (PMU) and specially licensed by the Bureau
of Food and Drugs (BFAD) to sell, distribute, offer for sale
and/or make available low-priced generic home remedies,
over-the-counter (OTC) Drugs and two (2) selected, publiclyknown prescription antibiotics drugs (i.e. Amoxicillin and
Cotrimoxazole).
The establishment of the Botika ng Barangay (BnB) in
the communities, including the insurgent areas, ensures
accessibility of low-priced generic over-the-counter drugs
and eight (8) prescription drugs as recommended by the
National Drug Formulary Committee. Under Memorandum #
31 and its amendment, as much as 40 essential medicines
that address common diseases can be made available in BnBs
depending on the morbidity and mortality profiles of the
community. And the policies surrounding the BnB (AO 144)
ensure that such can be sustained in the medium term.
II. Objectives
The objectives of this Order are as follows:
1. To promote equity in health by ensuring the availability
and accessibility of affordable, safe and effective,
quality essential drugs to all, with priority for
marginalized, underserved, critical and hard to reach
areas.
2. To integrate all related issuances of the DOH that
provides rules and regulations in the establishment and
operations of BnBs; and
3. To define the roles and responsibilities of the different
units of the DOH and other partners from the different
sectors in facilitating and regulating the establishment
of BnBs.

FAMILY PLANNING
A national mandated priority public health program to attain
the country's national health development: a health
intervention program and an important tool for the
improvement of the health and welfare of mothers, children
and other members of the family. It also provides information
and services for the couples of reproductive age to plan their
family according to their beliefs and circumstances through
legally and medically acceptable family planning methods.
The program is anchored on the following basic principles.
Responsible Parenthood which means that each family
has the right and duty to determine the desired
number of children they might have and when they
might have them. And beyond responsible parenthood
is Responsible Parenting which is the proper ubringing
and education of chidren so that they grow up to be
upright, productive and civic-minded citizens.
Respect for Life. The 1987 Constitution states that the
government protects the sanctity of life. Abortion is
NOT a FP method:
Birth Spacing refers to interval between pregnancies
(which is ideally 3 years). It enables women to recover
their health improves women's potential to be more
productive and to realize their personal aspirations and
allows more time to care for children and
spouse/husband, and;
Informed Choice that is upholding and ensuring the
rights of couples to determin the number and spacing
of their children according to their life's aspirations and
reminding couples that planning size of their families
have a direct bearing on the quality of their children's
and their own lives.
Intended Audience: Men and women of reproductive age
(15-49) years old) including adolescents
Area of Coverage: Nationwide
Mandate: EO 119 and EO 102
FOOD FORTIFICATION PROGRAM
Objectives:
1. To provide the basis for the need for a food fortification
program in the Philippines: The Micronutrient Malnutrition
Problem
2. To discuss various types of food fortification strategies
3. To provide an update on the current situation of food
fortification in the Philippines
Fortification as defined by Codex Alimentarius
the addition of one or more essential nutrients to food,
whether or not it is normally contained in the food, for the
purpose of preventing or correcting a demonstrated
deficiencyof one or more nutrients in the population or
specific population groups
Vitamin A, Vitamin A Deficiency (VAD) and its
Consequences

Vitamin A - an essential nutrient as retinol needed by

Lactating Women
100-200
the body for normal sight, growth, reproduction and
Pregnant Women
150-249
immune competence
< 20
Vitamin A deficiency - a condition characterized by Proportion < 50g/L, %
depleted liver stores & low blood levels of vitamin A
6-12 yrs.
35.8
due to prolonged insufficient dietary intake of vit. A
followed by poor absorption or utilization of vit. A in Lactating Women
the body
Pregnant Women
VAD affects childrens proper growth, resistance
*ICC-IDD 2007
to infection, and chances of survival (23 to 35%
increased child mortality), severe deficiency results to
Policy on Food Fortification
blindness, night blindness and bitots spot
ASIN LAW
Republic Act 8172, An Act Promoting Salt Iodization
Prevalence of Vitamin A Deficiency:
Nationwide and for other purposes, Signed into law on Dec.
1993, 1998, 2003, 2008
20, 1995
(DOST FNRI, NNS)

Physiological State

1993

1998

2003

2008 FOOD FORTIFICATION LAW

6 months - 5 yrs.

35.3

38.0

40.1

15.2

Pregnant

16.4

22.2

17.5

9.5

Lactating

16.4

16.5

20.1

6.4

WHO Cut off Point to be considered a public health

problem = >15%
Iron and Iron Deficiency Anemia (IDA) and its
consequences
Iron - an essential mineral and is part of hemoglobin,
the red protein in red blood cells that carries oxygen
from the lungs to the cells
Iron Deficiency Anemia - condition where there is
lack of iron in the body resulting to low hemoglobin
concentration of the blood
IDA results in premature delivery, increased maternal
mortality, reduce ability to fight infection and
transmittable diseases and low productivity
Prevalence of anemia by age, sex and physiologic state:
Philippines, 2008
Iodine and Iodine Deficiency Disorders (IDD)
Iodine -a mineral and a component of the thyroid
hormones
Thyroid hormones - needed for the brain and
nervous system to develop & function normally
Iodine Deficiency Disorders refers to a group of
clinical entities caused by inadequacy of dietary iodine
for the thyroid hormone resulting into various
condition e.g. goiter, cretinism, mental retardation, loss
of IQ points
Progress in the Philippines towards the Elimination of
IDD, 1998-2008
Indicator

Proportion of Households using Iodized Salt, %

Median Urinary Iodine, ug/L

6-12 yrs.

111

81

142

105

11.4

19.7

23.7

34.0

18.0

25.8

Republic Act 8976, An Act Establishing the Philippine Food

Fortification Program and for other purposes mandating
fortification of flour, oil and sugar with Vitamin A and flour
and rice with iron by November 7, 2004 and promoting
voluntary fortification through the SPSP, Signed into law on
November 7, 2000

Status of the Philippine Food Fortification Program

Status and Recommendations for the Sangkap Pinoy Seal
Program
There are 139 processed food products with
SangkapPinoySeal with 83% with vitamin A, 29% with
iron and 14% with iodine (2008)
37% of the products are snack foods
Most of the products FDA analyzed are within the
standard
Based on 2003 NNS Households awareness of SPSand FF-products is 11% and 14%, respectively, in 2008
awareness is 11.6%
Although awareness is low, usage of SPS-products is
99.2%
Recommendations:
Review voluntary fortification standards as standards
were developed prior to mandatory fortification
Conduct in-depth analysis of the coverage of
SangkapPinoySeal of the 2008 NNS
Update list of Sangkap Pinoy Seal products as some
companies have stopped using the seal in their
products
Intensify promotions of Sangkap Pinoy Seal

Status and Recommendation on Flour Fortification with

Achievements
Vitamin A and Iron
1998 2003 2008 Based on FDA monitoring all local flour millers are
fortifying with vitamin A and iron
>90
9.7 56.0 81.1
94% and 92% of all samples tested by FDA in 2009
were fortified with vitamin A and iron respectively while
100-200 71
201 132
77% and 99% were fortified with vitamin A and iron
Goal*

respectively. In 2010 decrease in vitamin A due to nonfortified imported and market samples flour.
58% of samples from local mills for vitamin A and 67%
of imported flour for iron were fortified according to
standards.
Recommendations:
Review fortificantsfor iron and possible other
micronutrients to be added to wheat flour
Continue monitoring wheat fortification
Assist flour millers to improve quality of fortification
Need to show impact of flour fortification
Status and Recommendations on Mandatory Fortification
of Refined Sugar with Vitamin A
Non fortification by industry due to the unresolved
issue of who will bear the cost of fortification brought
about by the quedansystem of transferable certificates
of sugar ownership.
Lack of premix production
Fortification of refined sugar would benefit mainly
those in the high income group.
Recommendations:
Continue discussions with sugar industry to explore a
compromise for fortification ie. fortification of washed
sugar
Review policy on mandatory fortification of refined
sugar
Status and Recommendations on Rice Fortification with
Iron
NFA is fortifying 50% of its rice in 2009 and 2010
With the non fortification of NFA rice, private sector
has an excuse for non fortification of its rice.
There is limited commercial/private sector iron rice
premix and iron fortified rice production and
distribution mostly in Mindanao (Region XII and XI)
with Gen San having the only commercial iron rice
premix plant in the Philippines and Davao City
implementing mandatory rice fortification in food
outlets
NFA conducted communications campaign for its iron
fortified rice thru the so called I-rice campaign
though issues remain on the acceptability of its
product
Recommendation:
Review of mandatory fortification of rice with iron
Status and Recommendations on Cooking Oil
Fortification with Vitamin A
Based on the samples analyzed by FDA in 2009 and
2010, more than 90% are fortified (91% in 2009 and
94% in 2010)
Samples monitored were labeled and packed
FDA is not monitoring "takal"
Recommendations:
To increase frequency of monitoring by FDA and other
agencies such as PCA and LGUs, to ensure all oil

refiners and repackersare monitored at least once a

year
Monitoring of takal oil, use of test kit
Monitoring imported oil, FDA and BOC to coordinate
Review policy of mandatory fortification of oil to
possibly limit to those mostly used by at risk
population (coconut and palm oil)

Status and Recommendations on Salt Iodization

Based on the 2008 NNS, 81.1% of households were
positive for iodine using Rapid Test Kit (RTK)
In the same survey for Region III, 55.7% were positive
for RTK but only 34.2% and 24.2% have iodine content
>5ppm and >15ppm respectively using WYD Tester
For FDA monitoring in 2010, 88% were >5ppm while
44% were >15ppm
FDA started implementing localization of ASIN Law
with General Santos City as the 1stto have a MOA with
FDA on localization
Recommendation:
FDA to expand localization of ASIN Law
Set up iodine titration for testing iodine in salt
Continue to intensify monitoring particularly imported
and takal salt
Food Fortification Day Theme 2010:
EO 382 declares November 7 as the National Food
Fortification Day
NATIONAL TUBERCULOSIS CONTROL PROGRAM
In 2007, there are 9.27 million incident cases of TB worldwide
and Asia accounts for 55% of the cases. Through the National
TB Program (NTP), the Philippines achieved the global targets
of 70% case detection for new smear positive TB cases and
89% of these became successfully treated. The various
initiatives undertaken by the Program, in partnership with
critical stakeholders, enabled the NTP to sustain these
targets. Nonetheless, emerging concerns like drug resistance
and co-morbidities need to be addressed to prevent rapid
transmission and future generation of such threats. Coverage
should also be broadened to capture the marginalized
populations and the vulnerable groups namely, urban and
rural poor, captive populations (inmates/prisoners), elderly
and indigenous groups.
Last 2009, the National Center for Disease
Prevention and Control of the Department of Health led the
process of formulating the 2010-2016 Philippine Plan of
Action to Control TB (PhilPACT) that serves as the guiding
direction for the attainment of the Millenium Development
Goals (MDGs). Learning from the Directly-Observed Treatment
Shortcourse (DOTS) strategy, the eight (8) strategies of
PhilPACT are anchored on this TB control framework.
Moreover, these strategies are also attuned with the
Governments health reform agenda known as Kalusugang
Pangkalahatan (KP) to ensure sustainability and risk
protection.
Vision: TB-free Philippines

Goal: To reduce by half TB prevalence and mortality

compared to 1990 figures by 2015
Objectives:
The NTP aims to:
1. Reduce local variations in TB control program
performance
2. Scale-up and sustain coverage of DOTS
implementation
3. Ensure provision of quality TB services
4. Reduce out-of-pocket expenses related to TB care