GUIDELINES IN FILLING UP THE SURVEY FORMS
& IN TABULATING THE DATA
1. Interviewee should also be included in the list of family
members
2. Members are only applicable to those who are at present
residing with the family, and this will include relatives and
helpers.
3. Marital Status
a. Single (S)- a person who is not and has never been
married
b. Married (M)- a person living with another as a couple
married by legal rite/s.
c. Common-law (CL)- a person living with another as a
couple not married by legal rite/s.
d. Widowed (W)- a person whose spouse is dead and who
has not remarried
e. Separated/ Divorced (Sep)- a person legally separated
from his/her spouse because of marital discord or similar
reason/s. a person whose bond of marriage has been
dissolved and can therefore re-marry.
4. Age distribution- Erickson’s Stages of Development
a. Birth to 18 months- infancy
b. 18 months to 3 years- early childhood
c. 3-5 years- late childhood
d. 6-12 years (11 years and 11 months)- school age
e. 12-18 ( 17 years and 11 months)-school age
f. 18-35 years ( 34 years and 11 months)- young adulthood
g. 35-65 years- adulthood
h. 65 years to death- maturity
* Take note of the demarcation line between ages.
DOH:
10-24 years- young person
25-59- adults
60 & up- older person
5. Types of work
a. Full-time work- Employment that is based upon a
contract of employment for a standard hour engagement
(generally between 35- 40 hours per week)
b. Part-time work- Work performed by any employee who
is engaged for a no. of hours, fixed or varied, but are fewer
than those specified as standard hours in the relevant award.
c. Casual work- A casual worker is someone hired by an
employer on an hourly or daily basis. Casual workers should
be employed to perform work of a short-term, irregular or
seasonal nature, either working full time or part time hours.
d. Temporary/contract work- Temporary employees are
often employed for a specific time period to complete a
particular project or to replace employee absent on leave.
e. Self-employment
f. Classification can also be:
- Farmer
- Housekeeper
- DH
- Employee
- etc…
6. Highest Educational Attainment- Refers only to the
highest level completed in the regular and formal system of
education, i.e. elementary, high school and collegiate
education. Excluded are attendance in nursery and
kindergarten schools and in purely vocational courses such as
dressmaking or carpentry. Enter only the last level of
education completed and the one the person is in at the time
of assessment.
a. For the Elementary level, write G-1 to G-6 (Grade 1-VI)
b. For High school, HS-1 to HS-4 and
c. For College education, C-1 to C-4, as the case maybe. For
degree holders, write the degree, e.g. BSE or BSN
7. Religion
a. Islam
b. Christians
1. Christian denominations
1.1 Catholics
1.2 Protestants
- Baptist
- etc
8. Immunization Status
a. Fully immunized child (FIC)- a child who received one
dose of BCG; 3 doses of OPV; 3 doses of DPT; 3 doses of
HB and one dose of measles before a child’s first birthday
b. Complete- a child who received all required vaccine
based on his/her age
c. Incomplete- a child who has incomplete required vaccine
based on his/ her age.
d. none
9. Nutritional status
a. Normal
b. Underweight
c. Overweight
10. Construction materials used for house
a. Light- refers to such materials as bamboo, nipa, sawali,
coconut leaves or cardboard.
b. Mixed- refers to a combination of light materials, wood
and/or concrete.
c. Strong- refers to a predominantly concrete house
11. Number of rooms used for sleeping- this refers to the
number of rooms in the house, not necessarily private
bedrooms that are used as sleeping area. Write the number.
12. Toilet facilities
a. Overhung latrine- the toilet
house is constructed over a body of
water (Stream, lake or river) into
which excreta is allowed to fall freely
b. Open pit privy- consists of
a pit covered by a platform with
a hole. The hole is not usually
not covered. The platform may,
in its simplest form, consists
only of two pieces of wood or
bamboo.
C. Closed pit privy- a pit privy in which
the hole over the platform or toilet floor is
provided with cover
E. Bored- hole latrine- consists of a
deep (usually more than 10 feet) but
relatively narrow (Lee than 2 feet in
diameter) hole made with a boring
equipment
F. Water-sealed latrine- nonantipolo type of toilet, boredhole latrine or any pit privy
wherein water- sealed toilet
bowl is placed instead of the
simple platform hole.
SPOT MAP/ COMMUNITY HEALTH DATA
SHEET(whole purok and per block)
• Individual households, locations and distances from
each other
• Physical characteristics of the community such as:
- waterways ( river, etc…)
- land use (rice fields, etc)
- Public service infrastructure (bridges, etc)
- Non-residential structures (churches)
- Boundaries of the purok
- All types of water sources
G. Flush type- a toilet system where waste
is disposed by flushing water through
pipes (sewers) into a public sewerage
system or into an individual disposal
system like an individual septic tank.
H. Pail system- a pail or box is used to
receive the excreta and disposed later
when filled, this includes the “balot”
system wherein excreta is wrapped in a
piece of paper or plastic and thrown later.
-The community health datasheet is like a spot map. It gives
you an idea about the health status of families and guides
community managers in planning projects needed by the
community.
-The health indicators are provided on the datasheet. The
color coding stand for health status or condition of each
household.
i. Antipolo type- the toilet is elevated and
the shallow pit is extended upwards to
the platform (toilet floor) by means of a
chute or pipe made of clay, metal,
aluminum or board
-The household datasheet. Individual presentation of every
household presented as data matrices that contain
information.
- health programs (columns)
- Colors in the cells (value-entry)
13. Storage of water
a. large- contain 4 gallons or more
14. Drainagea. Open- waste water flows through a system of pipes (could
be improvised from bamboo) to an open pit or canal
b. Blind –waste water flows through a system of closed pipes
to an underground pit or covered canal.
c. None- water flows freely from source to the ground or
thrown to the ground after being used.
15. waste disposal
a. hog feeding- garbage is used as a hog fee
b. open dumping- refuse and or garbage is piled in a dumping
place (w/or w/o pit) with no covering
C. Open burning- regularly piles refuse/garbage piled in a
dumping place [w/ or w/o pit) with no soil covering then
burns them
D. Burial pit- refuse/garbage is placed in a pit and covered
when filled up. There is no intention to dig it up later for use
as fertilizer.
E. composting- involves burying or stacking of alternating
layers of organic-based refuse/garbage and “treated coil”
arranged so as to hasten rapid decay and decomposition into
compost. This organic mixture can later be used as fertilizer.
F. garbage collection-refuse/garbage collected by garbage
truck or any type of garbage collection in the community.
REMINDERS:
Survey forms
• Submit with the list of households surveyed in
alphabetical order
• Arrange the forms per purok/sitio
• Number the forms based on its number in the spot
map
• Summarize the data using the guide below
No.
Head of the
Family
Partner
No.
of
children
I
P
FP
N
W
GD
T
Meaning of the colors:
- Red (Stop, danger)
- Yellow (needs improvement, caution)
- Green (go, safe)
- Blue (None, not applicable)
The health datasheet keep an eye on at least seven(7) public
health programs in the households of a community. This
programs are the health indicators:
- Immunization
- Prenatal
- Family planning
- Nutrition
- Water
- Garbage disposal
- Toilet
COMMUNITY HEALTH PLAN AND GANNT CHART
GANNT chart
• Visual representation of a project schedule
• A type of bar chart that shows the start and finish
dates of the different required elements of the project
• Typically, tasks are shown on the vertical axis, and
the project time span on the horizontal axis
• Each task has a corresponding bar that shows the
time span required for the task
• Developed by Henry Laurence Gannt, an American
mechanical engineer
Example of GANNT chart:
Community Health Plan Example:
Community
Organizing
Participatory
Action
Research
Community Organizing
 Process by which health services, agencies, and people
of the community brought together to:
- Identify/learn their own problem
- Plan activities
- Act on this basis
- Evaluate
COMMUNITY ORGANIZING EMPHASIZE
Strengthening the community members capability in:
- Problem solving skills and
- Decision Making skills (Necessary for self reliant
development)
Roles and Responsibilities of a Community Health Nurse
Manager
Guide
Advocate
Coordinator, Counselor, Change Agent
Health Care Provider
Nurse Trainer
Researcher
Organizer
Leader
Educator – Primary role, Primary responsibilities 
promotion of health and prevention of illness
Supervisor
Community Organizer
 Person who mobilize:
Individual
Family
Sick or Well
Community
To come together in unity and collectively address given:
Issues
Needs
Problem
* assess by way of research
PARTICIPATORY ACTION RESEARCH
 Is an investigation on problems and issues of the
community by way of research.
 Representatives of community participates in the
actual research.
- Local Researcher
- Outside Researcher = Community Health Nurse
 Act as researchers themselves, doing research of
their own problem.
 The essential element of Participatory Action
Research is participation
Participatory Action Research Objectives:
- To encourage consciousness of the suffering
- To empower people to determine the cause of their
own problem
- To analyze these problem
- To develop competence for changing their own
situation
- To act by themselves in responding to their own
problems
Ideal participatory research process involves the
community in all research aspect
1. Identification of research problem
2. Formulation of research design
3. Data gathering
4. Validation of research
5. Data presentation
6. Recommendations
7. Action of activities
COPAR Phase/Process
PRE ENTRY PHASE
At the NGO level
- Formulation of institutional goals, objectives and
targets for the program
- Revision of curriculum
- Training of faculty if CO-PAR
- Coordinate participation of other departments
within the institution
At the community level
- Community consultations/dialogues
- Setting of issues related to site selection
- Development of criteria for site selection
Criteria in selecting community
- Site must be
- Depressed and underserved
- Oppressed
- Poor
- Exploited
- Struggling
-Area must not have a serious peace and order problem
- Willingness to be organized
-Community needing health assistance
* Check vital health statistic  can determine general health
status
* Malnutrition rate
* Lack of health facility/health care providers
- Counter-part of the community (support, commitment,
resources)
- Accessible to transport and communication
At the community level
o
o
o
Site selection
Preliminary Social Investigation (PSI)
 Identify contact person
 Gather “overview” of the
demographic characteristics,
health services and facilities of
the community
Networking with LGU’s, NGO’s and
other departments
ENTRY PHASE
 Integration with the community  main objective: Gain Trust
First task  courtesy call to the Brgy. Captain
Establish rapport
* house calls
* joining to social activities
Imbibe their lifestyle
5 M’S
MANPOWER
MACHINE
MATERIAL
METHOD
Diria kay setting up lang, sa sustenance kay
MONEY
formalizing
SPACE
 Setting up of linkages/network/referral system
Immerse yourself
Live with them
Reside on the area
* live in the center/modest dwelling
•
•
•
Sensitization of the community  social preparation
Information campaign on health services
Continuing/deep social investigation
-
Process of collecting, collating, analyzing data to
draw the clear picture of the community

Core Group formation (CG)
o Consist of identified potential leaders
 Characteristics of a potential
leaders
Respected community members
Responsible/committed
Willing to work for a desired change
Has good communication skills
Has wide “influence” to elite/poor community
members
Self-awareness and leadership training (SALT)
Coordination with other community organization
o Representing different sectors of the
community
1.
2.
3.
4.
5.
-
SUSTENANCE AND STRENGTHENING PHASE
 Formulation and ratification of constitution and bylaws
 Identification and development of “secondary”
leaders
 Setting up a financing scheme
 Continuing education and training of BHW’s
 Development of long term community health
development plans
 Formalizing linkages, networks and referral system
TURNOVER / PHASE OUT
 Transfer of community organizer roles and
responsibilities and documents
 subsequent follow-up
CO-PAR main goal is to attain COMMUNITY
DEVELOPMENT
BETTER QUALITY OF LIFE
* Basic needs are met
* Equal rights
* Self-reliance
* Active participation
COMMUNITY DIAGNOSIS/STUDY PHASE
(research phase)
 Selection of the research team
 Training on data collection
 Planning for the actual gathering of data
 Data gathering
 Training on data validation
 Community validation
 Presentation of the community study/diagnosis and
recommendations
 Prioritization of community needs/problems for
action
COMMUNITY
ORGANIZING
/
CAPABILITY
BUILDING PHASE
 Community meetings to draw-up guidelines for the
organization
 Election of officer
Delegating key functions sa mga
 Development of management systems: leaders.
(Delineation of the Roles, Function, and Task of Officers)
 Training of leaders
 Team building exercises  to enhance cohesiveness
Action-Reflection-Action-Session
COMMUNITY ACTION PHASE
 Organization and training of BHW’s Village or
Grassroot Workers
 PIME of health services
Project
Implementation/Monitoring
and
Evaluation (Project Management)
 Resource mobilization
Dito mag-start na mag-act ang mga officers, and at the
same time, ga-determine and train din sila ng mga
BHW.
May PIME na and ginagamit (mobilize) na ang
resources