INTRODUCTION
Community Organizing Participatory Action Research is widely used framework in
public health nursing that aims to empower marginalized communities by giving them the
opportunity to engage in the research process where they play an active role as participants. As a
social development approach, it aims to transform poor communities into being participatory
and politically responsive ones. COPAR has registered positive impacts in communities that
agreed to take part in healthcare research in the Philippines. Also, it aims to transform the
apathetic, individualistic, and voiceless poor into a dynamic, participatory, and politically
responsive community. Also, the project ensures that the community will be able to sustain
development that encompasses environmental and economic continuance in sociodemographic
and health dimensions. It means development that meets the needs of the present without
compromising the ability of future generations to meet their own needs.
The social condition of the poor itself gives opportunities to conscientize the people.
The tactics should be within the experience of the people and outside the experience of the
target. People generally act based on their self-interest and human learns more effectively and
more deeply from his own actual experiences. The process of organizing moves from simple,
concrete, short term, and personal issues to more complex, abstract, long-term, and systemic
issues. Man needs to deepen and widen his horizon. Therefore, he must move from the
particular to the universal, from the concrete to the abstract, to apply one's experience and its
lesson to another situation. Throughout the organizing process, the people must make their own
decisions.
It is usually successful in building critical, self-reliant, creative grassroots organizations
Openness to experiment It is rooted in the community Generates immediate success It
immediately breaks the culture of silence, as an approach for empowering people, it is relatively
simple and can be learned easily by anyone.
THE ALMA-ATA DECLARATION OBJECTIVES of 1978
The objectives of the Alma-Ata Declaration of 1978 emerged as a major milestone of the
twentieth century in the field of public health, and it identified primary health care as the key to
the attainment of the goal of Health for All. The Conference strongly reaffirms that health,
which is a state of complete physical, mental, and social well-being, and not merely the absence
of disease or infirmity, is a fundamental human right and that the attainment of the highest
possible level of health is a most important world-wide social goal whose realization requires the
action of many other social and economic sectors in addition to the health sector.
The existing gross inequality in the health status of the people, particularly between
developed and developing countries as well as within countries, is politically, socially, and
economically unacceptable and is, therefore, of common concern to all countries. The people
have a right and duty to participate individually and collectively in the planning and
implementation of their health care. Primary health care is essential health care based on
practical, scientifically sound, and socially acceptable methods and technology made universally
accessible to individuals and families in the community through their full participation and at a
cost that the community and country can afford to maintain at every stage of their development
in the spirit of self-reliance and self-determination. It forms an integral part both country’s health
system, of which it is the central function and focus, and of the overall social and economic
development of the community. It is the first level of contact of individuals, the family, and
community with the national health system bringing health care as close as possible to where
people live and work and constitutes the first elements of a continuing health care process.
An acceptable level of health for all the people of the world by the year 2000 can be
attained through a fuller and better use of the world's resources, a considerable part of which is
now spent on armaments and military conflicts. A genuine policy of independence, peace,
détente, and disarmament could and should release additional resources that could well be
devoted to peaceful aims and to the acceleration of social and economic development of which
primary health care, as an essential part, should be allotted its proper share.
THE START OF P.H.C IN THE PHILIPPINES OF 1979
The signing of the letter of instruction 949 on October 19, 1979, by the late former
President Ferdinand Marcos, was the legal basis of the Philippines Primary Health Care to
formally instructs Honorable Enrique M. Garcia, the appointed Health Minister, to take charge,
supervise and coordinate all health-related activities within the Philippines and integrate the PHC
programs for the national health development.
The LOI 949 of 1979 demands the ministry of health to design and implement programs
that will focus on health development at the community level through empowering the primary
healthcare delivery system to develop a robust primary healthcare model in partnership with
government sectors. Also, the LOI 949 of 1979 will effectively utilize the PHC model for
eradicating the immediate and specific health problems of communities by Strengthening and reorienting existing specific programs in family planning, nutrition, malaria eradication,
schistosomiasis control, cancer control, and others to conform to the thrust of the peripheral
services, develops a plan to eradicate tuberculosis employing a solid program which integrates
into the health development at community levels.
In addition, the LOI 949 of 1979 redirects and re-orients the organization of all its
agencies at the central level to provide efficient and adequate administrative, planning, and other
support services for health development by strengthening staff function and capabilities and
streamlining their program of activities.
DECLARATION OF ASTANA OF P.H.C – 2018
In Astana on October 27, 2018, the Global Conference on Primary Health Care
organized by the World Health Organization (WHO) and UNICEF welcomed a declaration to
strengthen primary health care in pursuit of health and well-being and pursue universal health
coverage—access for all to high-quality health care, without undue financial burden.
The Astana Declaration acknowledged the Alma Ata Declaration of 1978 commitment
to the fundamental role of strong primary health care for population health. At the same time, it
embraced the United Nations (UN) Sustainable Development Goals, stressed the importance of
equity, and advocated the concept for health as being fundamental for societal development.
The Declaration presents 3 interconnected components: empowered populations and
communities that can prioritize and co-design responses to their health needs; high-quality
primary care, integrated with public health; and multi-sectoral policy and action. Integrated
health systems with primary care as a core function are required for its implementation, which
must be linked to community services. It is the totality of this integration that is primary health
care.
In Astana, “primary care” and “primary health care” were used interchangeably, but it is
important to understand that primary care is a core function of primary health care, and as such
a priority. To implement, there is a need to build primary care research capacity globally. A
strong point of the Astana compared to earlier Declarations on primary health care is in its
connection to the UN Sustainable Development Goals. This connects the Astana Declaration,
strengthened by the High-Level Meeting on universal health coverage to the heads of state, and
not just ministries of health. Pursuing health as a condition for societal development will enlarge
partnerships and stakeholders for collaboration in health reforms.
Although the Declaration builds on high-quality primary care, a major shortcoming is its
failure to acknowledge the professionalism of this field, and the professionals with their expertise
to provide its value. This ignored an earlier WHO resolution that had stressed the importance of
primary care nurses, midwives, allied health professionals, and family physicians, with the need
of professional training and retention in their positions in communities around the world. This
stresses the importance of continued advocacy for high-quality primary care and the disciplines
and competencies required of its teams to deliver it.
A central lesson from Astana is that declarations and resolutions are only able to guide
policy when their content is consistently shared between all stakeholders. Here is a particular
responsibility for WONCA and NAPCRG with their status in the international domain of
primary care. Primary care is essential for realizing universal health coverage, therefore every
community around the world needs access to multidisciplinary primary care teams. Moreover,
Teaching, training, and research are essential in realizing this ambition, and primary care should
be an integral part of the education of future nurses, midwives, allied health professionals, and
physicians.
To ensure this, primary care must be part of every medical school and training institute
of health professionals globally. Training programs should be multidisciplinary, to support
robust primary care teams in every community of the world. The performance of primary care
teams must be supported by research and building a robust primary care research capacity and
infrastructure for the generation of new knowledge and the implementation of evidence and
policy is a high priority in low- and middle-income countries.
BRIEF HISTORY OF COPAR IN THE PHILIPPINES
The Declaration of Martial Law in 1972 led to the elimination of the formation of
groups/organizations. These grassroots activities were started by NGOs and church leaders such
as Urban and Rural Missionaries of the Philippines, Task Force Detainees of the Philippines,
Episcopal Commission on Tribal Filipinos, share and care Apostolate for Poor Settlers Saul
Alinsky (father of community organizing).
However, during the 1994 National Rural Community Organizing Conference,
Community Organizing was defined as a collective, participatory, transformative, liberating,
sustained and systematic process of building people's 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 and oppressive exploitative conditions.
The Human Resource Development program was developed and sponsored by the
Philippine center for population and development to make health services available and
accessible to depressed and underserved communities in the Philippines. The PCPD is a nonstock non-profit that serves as a resource center assisting institutions and agencies through
programs and projects geared toward the social human development of rural and urban
communities.
The HRDP I trained the faculty, medical and nursing students to provide health care
services to the far-flung barrios because of lack of human resources on the health services at the
same time that similar activities fulfilled the curricular requirements of the students for public
health. HRDP I is usually a short-term service, and the community organizer uses his/her
strategy method in generating the projects, and the PCPD provides seed money for the incomegenerating projects.
The HRDP II is the second cycle that uses the same strategy, but the schools or hospitals
cannot sustain the program, and the income-generating projects eventually become a hindrance
to the goal of achieving the health program because the people tend to be more interested in the
income generated by the projects. Both HRDP I and II have brought some changes in the
community life of the people since it established basic health infrastructure, and health services
were increased through trained workers and organized health groups to take care of the needs of
the community.
Finally, the PCPD refined the program and resulted in HRDP III, which has unique
features such as comprehensive training of the staff and faculty of the participating agency in
which the community work was initiated. Provides a regular training program and regular
assistance to the participating agency to strengthen the health outreach program to become
community oriented. Also, utilize Primary health care as the approach with which all nursing
/medical students, Clinical instructors, health workers and around which all other projects inputs
will revolve. It also introduces Community organizing as the primary strategy to prepare
communities to develop their community health care systems and establish community health
organizations to manage the community health programs.
In addition, HRDP III utilizes participatory action research as a fascinating strategy for
maximum community involvement through collective identification and analysis of community
health problems and collective health action.