MODULE 1

BASIC CONCEPTS OF COMMUNTIY

ORIENTED CARE and INTEGRATION TO
PFC MATRIX
OBJECTIVES OF THE MODULE
1. Present key terminologies and differentiate community health,
population health and public health
2. Discuss the Family Physician’s role in healthcare provision
3. Differentiate the approaches of patient-centered, family-
focused, and community-oriented care
4. Integrate the community-oriented care concepts to PFC matrix

DEFINITION OF TERMS
Community
It is a GROUP OF PEOPLE bound together under common characteristic.
The characteristic maybe of, location, race, ethnicity, age, occupation,
interest in particular problems or outcomes, or common bonds which
provides these people the sense of:

• Membership, defined as sense of identity and belongingness

• Common systems using similar language, performing common
rituals and ceremonies
• Shared values and norms to which people abides to
• Mutual influence where each member in one way or another will
have an influence over each other
• Shared needs and commitment
• Shared emotional connection through sharing of common history,
experiences where distinct support system is built
Community health – health status of a defined group of people,
encompassing promotive, preventive, curative, rehabilitative, and
palliative aspects of the care, where the action towards health may
come either from public or private sector.
Population health
It sounds alike with that of community health. It also encompasses the
spectrum of care (promotive, preventive, curative, rehabilitative and
palliative) delivered to target population, through public or private
sector. The target population in this case, most often than not is
defined through the geographic bounds, unlike that of community
health where target population are organized through distinct
characteristics.
Public health
This deals with the health situation of public at large. In this model, the
difference with population health is that the action largely in this model
is through the government.

WHAT IS HEALTH?

How do we define health? The origin of the word is from hal, which
means “hale, sound, whole.”
This means, health should make someone whole.
Hence, health is defined by the WHO as the “state of complete physical,
mental, and social well-being and not merely the absence of disease
and infirmity.”
The definition aims to achieve the “well-being” of an individual in
different aspects mentioned, that makes up our lives, which is beyond
just the mere absence of physical ailment.

Taking care of a health of individual disease condition is a two-way

process between the patient and their care provider.
FAMILY PHYSICIAN’S ROLE IN PROVISION OF HEALTH CARE

Family physicians, are professionals who is trained to provide care that

is patient-centered, family-focused, and community-oriented. And in
order to do this, we should be able to acquire the core competencies
shown in the diagram presented.

Each components represents the Philippine Academy of Family

Physicians’ (PAFP) vision on the outcome of a trained family physician.
This is recognized by the WONCA (World Organization of Family
Doctors) as vital pilar of competencies for what a trained family
physician should possess.
As seen, a well-trained family physician should be well versed to the
required role they may take in different instances.

Healthcare provider – Family physician should, first and foremost,

be an effective healthcare provider for their patient by providing
care that is updated and evidence based. But beyond this, a family
physician should also be a healthcare provider for the family, and
 community through identifying and incorporating the factors that
may aid in the care of the patient and their family (enablers) or by
making plans to tackle the workable hindrances that may
negatively affect the delivery of care. For the care of family, we
maybe able to do this by collecting data through judicious use of
the family assessment tools and analyzing them. In the case of
community-oriented care, we shall study and analyze the social
determinants of health and building blocks of health system.
Educator – Be an effective educator of updated and evidence-
based knowledge to his patient and colleagues
Coordinator / Navigator – Family physicians should be skillful in
coordinating the identified needs for care for the patient, family
and at times community, by effectively navigating the health
systems
Leader – By actively taking the leadership role for their own
practice (in the clinics), or by being the advocate for the
improvement of health status of the community
Researcher – Commitment as a lifelong learner through actively
contributing to the advancement in the knowledge of healthcare

PATIENT-CENTERED, FAMILY-FOCUSED, AND COMMUNTIY-ORIENTED

PRIMARY CARE

Patient-centered aspect will take care of

the ‘disease’ in an individual, with the
primary goal of providing cure. This refers
to caring for the ‘physical’ as to the WHO’s
definition.
However, a well oriented family physician should go beyond of
providing the cure. He should be able to assess the psychosocial aspect
of the ‘sickness’ in order to gain the perspective of their patient, which
will provide the care that is often being neglected in our daily patient
encounter. This process of rendering “care” refers to providing care of
the ‘mental’ as well as ‘social’ aspect of WHO’s definition of health.
The understanding being extended by their care provider, will validate
the “illness” suffered by each patients, which will make them more
amenable and cooperative to the plan of their health care provider,
hence achieving a mutual process.
Family-focused, and community-oriented care, on the other hand, will
take care of the ‘social’ aspect of the WHO’s definition of health.
Family is the basic unit of the society.
It is where a genetic transmission
occurs. Hence knowing the
characteristic genetic transmission in
the family line will give the care
provider an idea on the vulnerability of a person in developing certain
types of hereditary diseases.
Family will also serve as the matrix of personality development. This
will happen in the background of both the internal and external
influences that surrounds the person. Internal influences are gained
from the cultures and traditions of the family. Whereas the external
influences mostly are the socio-cultural factors that surrounds the
family. These are the environmental, economic, educational, as well as
social factors that will shape the personality. All these factors will
affect on how a patient, and a family will react to the ‘disease’ and
‘illness’ and will influence the course of actions they may take.
A family focused physician shall exhibits his expertise by reflecting
his/her understanding on effects of the familial factors that will
influence the course of treatment, and should integrate in to his/her
care plan of the patient and their family.
Community orientedness of a family physician will enable the expand
the care for a patient and their families beyond the paradigm of ‘usual’
care.
Community-oriented care is often mistakenly perceived as rendering
coordination to the financial needs of the patients. Although,
undeniably, financial assistance will mean a lot, especially in our
setting, community-oriented care should go beyond of coordinating the
financial needs.
Community-oriented physician should be able to see their patients and
the family, in the context of the community to where they belong.

While the family physician taking care of the individual and family’s
health needs, by providing medical and psychosocial care, a community
physician views the health situation through a bigger lens. A
community physician manages the healthcare needs of their patients in
the community by addressing the identified issues through careful
analysis of the social determinants of health.
 Social determinants of health are the
socioeconomic factors that are present in the
community. These factors affect the health
status of the population directly or indirectly.
Some of the factors may be managed by direct action of the patient
and their family. However, successful intervention on most of these
factors entail the expertise in navigating and coordinating ability of the
community physician.
Community-oriented family
physician should also be in
constant monitoring on the
situation of their
community’s building blocks
of health. Building block of
health is made up of variables
that a health system in a
community must possess.
These variables are the: (i) service delivery, (ii) health workforce, (iii)
health information system, (iv) access to essential medicines, (v)
financing, and (vi) leadership/governance. A community-oriented
physician should be able to identify changes to any of these factors in
order to assure comprehensive, continuing, and coordinated health
care delivery to their constituents.
Activities of a community-oriented physician that integrates the factors
in social determinants and building blocks of health are the following;
a. Measuring, monitoring, analyzing the health indices of the
community
b. Develop/adapt, and execute action that will help shape the
health of community (e.g.) health promotion activities, health
care delivery system
c. Monitor the action taken for improvement
d. Community organization to gain more involvement from the
community in taking care of their own health status

INTEGRATING THE COMMUNITY ORIENTED CARE TO THE PFC MATRIX

The question at this time is, how to integrate the knowledge and
activity of a community-oriented care, to the PFC matrix.

Shown is a table showing the major entry in the community-oriented

aspect of the PFC matrix table.
Understandably, data to be evaluated to serve as the basis for our
community-oriented diagnosis and intervention shall come from
assessment of the social determinants of health and the building blocks
of health system. However, as we see, there is additional data to be
assessed; which is the family assessment tools with community
components. Can we identify what are these? Yes. They are the
ECOMAP and the SCREEM.
SCREEM stands for (S) Social, (C) Cultural, (R) Religion, (E)
Economic, (E) Education, and (M) Medical. Undeniably, these
components are included in the social determinants of health.
And hence, assessing the SCREEM is equivalent to assessing the
social determinants of health in the context of family, which is the
direct reflection of it from the grassroots level.
ECOMAP is a diagrammatic representation of the assessed
resources (enablers) as well as potential pathologies (barriers)
that is present in the community to where the family lives. It is
inevitable that some components discussed in the SCREEM may
be reflected in the ECOMAP, since there is an overlapping
function between these tools. Hence, assessing the ECOMAP will
make us see the social determinants that surrounds a family.
There are two resulting interventions which are the Community
oriented primary care (COPC) approach, and the population health-
based approach. COPC approach will be taken up in depth once
enrolled in the family medicine residency training, and hence we will
not be taking up in this module. The other approach, which is the
population health-based approach will be tackled in the succeeding
modules.
REFERENCE:
Braveman, P., & Gottlieb, L. (2014). The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public
Health Reports, 129(1_suppl2), 19–31. https://doi.org/10.1177/00333549141291s206
Social Determinants of Health - an introduction. (2017, June 25). [Video]. YouTube.
https://www.youtube.com/watch?v=8PH4JYfF4Ns&t=73s
World Health Organization. (2010). Monitoring the building blocks of health systems: a handbook of indicators and their
measurement strategies. World Health Organization. https://apps.who.int/iris/handle/10665/258734