WHY PAR IN

MEDICAL
CURRICULUM

ROLES
CONTEXT OF PRACTICE
5 STAR M.D. HEALTH PROVIDER

SOCIAL
MANAGER MOBILIZER

Lasallian

RESEARCHER EDUCATOR
 BIOMEDICAL BIOPSYCHOSOCIAL
BASIC/CLINICAL FAMILY and COMMUNITY
MEDICINE
A M C T O O F C N C B
O E I R R
T A O A U I
L L S G G M M T L O
O E L S A A I M I T S
M C S U N N U O U P
S U E S L
S N N R H
L S Y
Y I E E
E
S T R
S
T Y E
E
M SOCIAL
ORGANISMI S
C hierarchy hierarch
y
 PARTICIPATORY
ACTION RESEARCH

CM 3 Department of Family and Community

Medicine
De La Salle Health Sciences Campus
Estrella P. Gonzaga M.D.
 INVESTIGATIO
L N
I PLAN
T
E
RESEARCH
R
A
T
U
R
E CONDUCT
R
E
V
I USE OF RESULTS
E
W ASSESS
 Research Plan
L
I Documentation
Planning
T Plan
E
R Evaluation Plan
A
T Work/ Field Plan
U
R CONDUCT
E

R
E
V
I
E
ASSESS USE OF RESULTS
W
L Planning
I
T 1.Analyse problem
E
R 2.Set rationale/ purpose
A
T 3.Define objectives
U
R 4.Select methods
CONDUCT
E
- Study population
R
- Variables
E
V - Data collection
I
E - Data analysisUSE OF RESULTS
W ASSESS
- Data presentation/ Report
L
I Planning
T
E
R
A
T
U 1.Pre- Test
R CONDUCT
E 2.Actual
conduct
R
E
V
I
E USE OF RESULTS
W ASSESS
Fundamental Belief
Recognition and Respect for the
inherent strength and capacity
(potential power) of people –
the poor and disadvantaged groups
to change their difficult
conditions and improve their lives.
 PEOPLE
ARE
THE
FOUNDATION OF A NATION
 But NOW
The
FOUNDATION IS WEAK
2/3 of People caught

POVERTY

ILLITERACY ILLNESS

APATHY

Interlocking problems
…NOT because they LACK THE
"BRAINS" but because they LACK
OPPORTUNITIES. (Y.C. James Yen)

POVERTY

ILLITERACY ILLNESS

APATHY

Interlocking problems
 “CREATIVE AND DYNAMIC LEARNING
process of finding with the people
the answers to
the questions of HOW and WHY,
the content and methods of concerns
- directly related to their lives
and
needs.”

(Y.C. James Yen. Tell the People)

ON
WHA
An investigation of problems and
T issues concerning the life and
environment of the
HOW underprivileged in society by way
of a research collaboration with
the underprivileged, whose
representatives participate in the
WHO
research process as equal
partners that is, as researchers
themselves, rather than outsiders
doing research upon them or their
problems (International Labor
Organization)
Impetus in Health
 1978 at Alma-Ata, Russia
 World Health Assembly adopted

HEALTH FOR ALL = Goal

PRIMARY HEALTH CARE = Key
Strategy
Impetus in Health
Community Participation- a key
principle to the strategy
(PRINCIPLE NO5)

Health is no longer the responsibility

of the doctor but of the individuals,
families and the community
PRIMARY HEALTH CARE …
essential health care 5

 Requires and promotes maximum

community and individual self-
reliance and participation in the
planning, organization and
operation and control of primary
health care,

COMMUNITY PARTICIPATION
 COMMON PITFALLS in
community work
ACTION WITHOUT RESEARCH

=stagnant practices,
=similar to running on a
treadmill
 RESEARCH WITHOUT ACTION

= Often shelved in the libraries, studies

are rendered sterile (or non-
productive).
 WHO DECIDES
L
I = WHOM TO
Planning STUDY
T
E
R = WHAT TO
A STUDY
T
U = HOW TO STUDY
R CONDUCT
E IS THIS THE TRUE
PICTURE?
R
E
V
I
E
W
ASSESS USE OF
RESULTS
WHO DECIDES:
= WHOM TO STUDY
= WHAT TO STUDY
= HOW TO STUDY
 WHOM to RESEARCH
(study)

 WHO NEEDS TO TALK vis-a-vis. WHO

ARE TALKING

 NOT a matter of number (1, 5, 10

etc) BUT
WHO DO THE NUMBERS
REPRESENT
Who Needs To Talk = study pop/
subjects
WHAT to RESEARCH
(study)
TYPES :
1) Broad Areas Community Development
2) Sectoral
a- Agriculture
b- Health
Maternal Health,
Reproductive Health /HIV AIDS
Water / Sanitation
Community Based Disaster
Management
•Giving Adolescents a Voice: Conducting a Rapid Assessment for
Adolescent Health Needs. A manual for health plannners and
researchers. WHO. WPRO. 2001.
HOW TO …
 SAME generic steps for investigation
(RESEARCH)

 Techniques (1o or
2o)

LOOK - 2o
1o
ASK 1o
DISCUSS 1o
TECHNIQUES:
1.Look (use of five senses)
- REAd: Documents/ Records Review
(Secondary DATA)
- MEASURE: Physical, Biochemical
Assessments
2. ASK : a. IN PERSON – Interview
KEY INFORMANT INTERVIEW
b. BY PRINT - Questionnaire
3. DISCUSS: FOCUS GROUP
DISCUSSION
meetings,
 DIFFERENCE:
1) DECISION MAKER
2) TOOLS (INSTRUMENTS)
same set of tools used from data
collection to data analysis
simple and with pictographs
RESEARCH Conventional Participatory
Action
Decision
Maker OUTSIDER INSIDER
Rationale √ √
Objectives √ √
Methods: data √ √
collection to
analysis

Report: oral, √ √
written
Use of results
GROUP DISCUSSIONS
Structured Learning Exercises
GAMES
 •Giving Adolescents a Voice: Conducting a Rapid
Assessment for Adolescent Health Needs. A manual
Example: for health plannners and researchers. WHO. WPRO.
2001. p22

THEME RELATED METHODS

ISSUES
ADOLESCENT Self – Secondary
REPRODUCTI perceptions data
VE HEALTH and concerns Primary data
CONCERNS - Interviews
- FGD’s
Perceptions FGD
of health Interviews
staff, parents
etc
• Wealth Ranking
•Venn Diagram –
Chart of relationships
•Mapping
•Transect
•Historical transect
MAPPING : Men’s View
•24 hours men/ women
Activity Chart
•Seasonal pattern chart
•Timeline
•Community life story
Participants Personal Symbols: Time line
TOOL DEFINITION USE
24 hour chart Graphical Time use and
representation sequencing of
of how tasks
participants Distribution of
spend their day tasks by
By gender; by gender
season (busy/
Historical lax)
Key events and Perception of
Timeline changes of significant
particular changes over
group and or time
place
•Webs (problems or solutions)
•Problem tree
•Health fence (solutions
•Flow Chart
e.g. Food path or water path
•Matrix Ranking
CONTENT: HEALTH FENCE
Health Fence
 WHO DECIDES
L
I = WHOM TO
Planning STUDY
T
E
R = WHAT TO
A STUDY
T
U = HOW TO STUDY
R WHO NEEDS TO
CONDUCT
E TALK VV WHO
ARE TALKING
R
E IS THIS THE TRUE
V PICTURE?
I
E
W
ASSESS USE OF
RESULTS
IS THIS THE TRUE PICTURE?
VALIDITY CHECK: TRIANGULATION

1.Who validates
2.What tools are
used
3.What are the
REALITY
sources of
information
IS THIS THE TRUE PICTURE?

1.Who
validates Insider/
Outside
r

REALITY
Multi-
Men/
disciplinary
Women
team
IS THIS THE TRUE PICTURE?
2. What tools are
used
Record
s
Review

REALITY

Observatio Discussion
n
IS THIS THE TRUE PICTURE?
3. What are the sources of
information
Person
s

REALITY

Places Events
Premise of Community Practitioner:
OUTSIDERS CAN HELP
but
INSIDERS MUST DO THE JOB
stems from
RESPECT FOR THE POTENTIALS
AND DIGNITY OF THE PEOPLE and
NOT FROM PITY.
Source: Y.C James Yen
 Outsiders(4C's
)

1. Competence -
Go with an open mind
Not a closed nor an empty mind
Essence not nonsense (Science
simplification)

2. Creativity
See what is invisible,
Do what is impossible
Source: Y.C James Yen
 Outsiders(4C's
)

3. Commitment
Fight on despite the odds, ready to
shed sweat, tears and lifeblood
4. Character
Catch not from his/her words but from
action, the spirit of unselfishness,
caring and love for our people

Source: Y.C James Yen

 Outsiders(4C's
)

COMPETENCE
CREATIVITY

Scientist

COMMITMEN
T
CHARACTER Missionary
Source: Y.C James Yen
Outsiders(4C's)
TEAM WORK =
INTERDISCIPLINARY APPROACH

Multiple Factors
Multiple Response

Source: Y.C James Yen

OUTSIDER = FACILITATOR
Can speak and understand the language
 Spoken : loss of meaning with
translation
 Body Language

Diarrhea Pagtatae, Pag-ite

Buntong sinuso, Sawan
OUTSIDER = FACILITATOR

 Can conduct group discussion

“ Noisy” and “Silent” handling
“ Consensus building”
“ Records views of Minority
including statistic of 1”
INSIDERS
- Representative
gender : man, woman,
age : young, old
place : each zone, remote areas
Hands on Training
- people schedule: day, time
- why, what and how of PAR
- validated with villagers
- reports results
STEPS in Conducting PAR

1.FORM the CORE RESEARCH TEAM

2.TRAIN THE CORE RESEARCH
GROUP ON PAR
STEPS in Conducting PAR

1.Core Group
-Sets Objectives , Conducts Literature
Review
-Choose methods based on objectives
- Sampling
- Data Collection
- Data Collation/ Organization
- Data Analysis
- Prepare Evaluation Plan
STEPS in Conducting PAR

4. Core Group implements PAR plan, work

plan
- Enters Community
- Collects data etc
5. Core Group validates data with community
6. Core Group prepares final report
7. Action Group negotiates for changes in
policies and procedures etc
 Planning
L
I
T
E
R
A
T CONDUCT
U
R
USE OF
E RESULTS

R
1.Negotiate
E 2.Planning
V
I ASSESS - policies
E
W - programs/ services
 USE OF
RESULTS

 Benefits have been described as

"empowerment" or "release of
their God-given inherent strength“
(preferable term) in
= analyzing and understanding
better their situation
= increasing their control over
resources and action to
improve their lives.
 TIME 0………

…NOT because they LACK THE

"BRAINS" but because they LACK
OPPORTUNITIES. (Y.C. James Yen)

POVERTY

ILLITERACY ILLNESS

APATHY

Interlocking problems
 …………..TIME
N
RELEASE..(Y.C. James Yen)

PRODUCTIVE

INTELLECTUAL PHYSICAL

ORGANIZING

PEOPLE’S POTENTIAL POWERS

 Participatory means people, particularly
the poor and underprivileged are
involved in all the phases of a
management process i.e. planning,
implementation, monitoring and
evaluation thereby owning the process
and enjoying the benefits derived from
it.
 PAR

Situation analysis

Planning
Evaluation

Implementation
Monitoring
 R
PA

Situation analysis
PA
R

PA
R
Planning
Evaluation

Implementation
Monitoring PAR
 Example: Project Benefit Review
Activity Year Score Impact Status/
s Sustainability
Health 2000 10 Mothers CHW continue
Awaren - aware of home visits
ess 2003 Child
Progra weighing,
m diet,
immunizati
Biogas 2003 7 on
Third of Resource
- households committee in
2004 With search of
electricity funds
on biogas
 References
1. Training Manual of Rural Reconstruction Nepal
Field Workers on Community Health in Rural
Development. Regional Office for Asia,
International Institute of Rural Reconstruction.
October, 1997
2. Training Resource Book. International Institute
of Rural Reconstruction. 1986
3. Recording and Using Indigenous Knowledge: A
manual. International Institute of Rural
Reconstruction. 1996.
4. Participatory Learning and Action issues. IIED
5. Giving Adolescents a Voice: Conducting a
Rapid Assessment for Adolescent Health
Needs. A manual for health plannners
and researchers. WHO. WPRO. 2001.
PAR FOR THIRD YEAR CM
Life of a Third Year DLS CM
 Group Work
 1. Separate the Men from the Women
 2. Each gender count off from 1 to 5
 3. Each group selects the rapporteur
 4. The five rapporteurs randomly
selects a category
 5. Group discussion – 30 minutes

Writes names/ signature on

newsprint
Life of a Third Year DLS CM

 1. Prepare the Tool assigned to the

group
 2. Write your
 Observations
Relate observations to
“WHAT MATTERS MOST”
Life of a Third Year DLS CM
PLENARY
Rapporteur – presents in 10
minutes
Group - Clarifies
Other Groups Comments : adds/
modifies
Comparing the female/ male
outputs, what are the
similarities? Differences?
BOARD LAY-OUT
Post the outputs on the blackboards as shown
below:

SChart - Map – 24hr – Barrier – Venn

Females/ Males
 DIFFERENCE:
1) DECISION MAKER

2) TOOLS (INSTRUMENTS)
same set of tools
from data collection to data analysis
simple and with pictographs
IS THIS THE TRUE PICTURE?
VALIDITY CHECK: TRIANGULATION

1.Who validates
2.What tools are
used
3.What are the
REALITY
sources of
information