INTRODUCTION TO HEALTH • thus-implying a sense of place, locale

LESSON 1 or geographical boundaries.

• neighborhood, a village, a city or
HEALTH : Philippine 1987 Constitution country
Article II, Section 15
2. Sharing ( of common interests and
"shall protect & promote the right to perspectives)
health of the people & instill health • existence of "shared perspectives" and
consciousness among them.” common interests'
• values, ideologies, vision, activities,
HEALTH jargons, passions, opinions, interests,
state of complete physical, mental & social history, even skin color and sexual
well being & not merely the absence of a identity.
disease or infirmity-WHO.
3. Joint Action
as more than just a biological or • “source of community cohesion and
physiological manifestation of wellness identity"
• "naturally to the creation of
Social well-being implies not only is a community”
person free from any physically debilitating • joint actions of people through
illness but is also free from any socializing, hanging out, conversing.
impediment that will obstruct him or her volunteering together, praying
from achieving his or her personal goals together, working together and
and aspirations in life getting things done together.

For example, poverty can be an 4. Social ties

impediment • “interpersonal relationships”
foundation of the community.
COMMUNITY • Types of relationships include family,
As part of a community, the individual parents, siblings, cousins; roommates,
must endeavor to become a productive house- hold; lovers, partners; friends,
member of the community lest he or she neighbors, acquaintances; CO-
be ostracized from the community. workers, role models and support
groups, among others.
a person would thrive better, he or she is
• create ties with other people
part of a community he or she identifies
with.
5. Diversity
• the concept of diversity goes beyond
The word community can be a vague term
more than just culturally based ethnic
among experts particularly in the field of
distinctions.
Sociology.
• "larger societal view of community
and made reference to differences in
In a study by MacQueen (2001)
interpersonal interaction"
A community has five core elements:
• "communities within a community" or
1. Locus ( sense of place )
interwoven groups brought about by
• something which can be located or
described
 variations in interactions among The community can be further dissected
members of the community. into other forms of systems such as the
health system, political system, or social
COMMUNITY DEVELOPMENT class system which can either be based on
United Nations broadly defines ethnicity, religious affiliation or economic
community developmeny as a class.

“process where community members come COMMUNITY HEALTH

together to take collective action &
generate solutions to common problem.” The field of community health is a sub-set
of Public Health.
very vital especially in the aspect of
national development and sustainable Charles Edward Amory Winslow (1920)
progress. “the science and art of preventing disease,
prolonging life and promoting physical
The development of a nation depends on health & efficiency through organized
the rate of progress made at the community efforts of sanitation of the
community level. environment, the control community
infections, the education of the individual
means by which individual members of a in principles of personal hygiene, the
community are empowered to create organization of medical & nursing service
sustainable growth and progress based on for the early diagnosis & preventive
justice and equity treatment of disease & the development of
the social machinery which will ensure to
process requires active participation and every individual in the community a
contribution of the members standard of living adequate for the
maintenance of health".
process geared towards changing
institutions and structures that will nurture Public health was always then
equitable progress at all social aspects. associated with Environmental Sanitation
due to the biological link between
In order to bring about change, change at unsanitary living conditions and practices
the community level may be the right with diseases (Germ Theory).
approach.
Winslow also believed that public health is
After all, the problems people face are also concerned with the prevention of
mostly social and not individual or development of non-infectious diseases or
personal. lifestyle-related diseases including mental
disorders and diseases associated with
System is an organized collection of units poverty.
interacting in various forms in order to
accomplish specific function or goal. Marc Lalonde (1981)
a canadian minister of national Health &
A system may be simple or complex. It can Welfare.
be open (interacting with other systems)
or closed. working document "A new perspective on
the Health of Canadians" a Health Field
Concept which is a framework in analyzing contact or consultation of the patients
problems in the public health field. w/in a healthcare system.

the "health field" can be broken up into • services in barangay / village,

four broad elements: midwife/public health nurses
• Human Biology
• Environment • the first point of contact would be the
• Lifestyle family physician or a general
• Health Care Organization. practitioner (primary care physicians)

Human Biology • deals w/ preventive care, performing

element as aspects of health, both physical strategies & interventions
and mental, which are developed within
the human body • maternal & child health services
(immunizations, family planning,
"as a consequence of the basic biology of antenatal and perinatal care)
man and the organic make-up of the
individual" Primary care services are usually available
at rural health units or barangay health
Environment stations, although they can also be given at
matters related to health which are hospitals.
external to the human body and over
which "the individual has little or no Secondary care - provided by medical
control." specialists & other medical professionals
whom a primary care professional has
Lifestyle referred to.
"aggregation of decisions by individuals
which affect their health and over which this requires more specialized type of
they more or less have control." services and more complex.

Health Care Organization Types of services provided are more

most of the society's efforts in improving complex in nature than the ones being
health have been focused solely provided for at the primary level.

“quantity, quality, arrangement, nature Tertiary care is more specialized and

and relationships of people and resources advanced.
in the provision of health care.”
Services are far more advanced
LEVELS OF HEALTH CARE considering that the medical cases referred
There are three levels of health care: to this level are far more complex
1. Primary,
2. Secondary • the number of patients being catered
3. Tertiary are fewer than those compared w/
primary & secondary because medical
Primary care services provided by health cases are more difficult & diagnostics
care professional acting as first point of procedures are complicated &
advanced.
 1. Physical environment - in which
• Cancer mgt, surgical procedures like people live, such as the quality of the
neurosurgeries. air they breathe and the water they
drink;
REFERRAL PROCESS
The process by which a patient is 2. Social environment - the level of
transferred from one level or point of care social and emotional support people
to another. receive from friends and/or family;

• begins at home 3. Poverty- a significant factor

• the patient according to his/her worldwide, which shortens and
understanding of his/her illness, reduces enjoyment of life;
chooses to seek care from a health
care professional, performs self 4. Behaviour and lifestyle - for example,
medication or self care and or seek smoking causes lung cancer and
alternative routes of treatment. coronary heart. disease so a reduction
• two way process, which means a in this behaviour will reduce the
patient recovered from illnesses will disease;
continue receiving care at home must
be referred back to the immediate 5. Family genetics and individual
health facility - Return referral biology- if you come from a healthy
process. family you have a better chance of
staying well.
DELAYS
• First delay - a delay of seeking care These factors remind us that Public Health
• Second delay - a delay in the or Community Health is not just a matter
transport of patients from the health of presence or absence of a disease.
facility to higher level of care.
• Third delay - a delay if the patient may COMMUNITY PROFILING DATA
not be able to receive urgent and
appropriate care due to unavailability In collecting information about the
of med specialist or supplies. community through a community
profiling, certain data must be considered
Community Health Epidemiology & in order to get a bigger picture about the
Human Behavior community's health status.
LESSON 2
In the same document from WHO, the
COMMUNITY HEALTH NEEDS following data are recommended to be
ASSESSMENT (WHO) considered when one does community
profiling.
The following are the factors as cited from
WHO'S Community Health Needs A. WORK AND LEVELS OF EMPLOYMENT
Assessment (2001) published by the WHO AND UNEMPLOYMENT
Regional Office for Europe:
in a community are fundamental to health
for the following three reasons:
Occupational diseases. All work affects number of factors should be monitored
health, both positively and negatively. here.
However, some work is known to cause
disease, such as silicosis in mine and Pollution of air and water causes disease
quarry workers and machinery accidents and death and this is evident throughout
among farm workers. New work- related the world, whether it is lead in petrol or a
illnesses are also being recognized, such as chemical spill from a factory, or drinking
repetitive strain injury for keyboard water contaminated by sewage.
operators.
Good sanitation eliminates some diseases
Income levels. The amount of income such as cholera and dysentery completely,
people earn has an important influence on and where it is absent, gastrointestinal
their health, affecting their ability to illnesses are quickly evident. In
choose a healthy lifestyle and to access communities lacking basic sanitation,
health services. Levels of income also have threats to health arise from the
an impact on the local economy within a contamination of water supplies by human
community. excreta.

Self Worth. At the same time, the status of The lack of a home affects all aspects of
an occupation affects how people feel health - shelter from the weather, an
about themselves. People's level of environment to sustain a family, a place to
satisfaction at work contributes to their feel safe. The availability and type of
well-being. Many define people by their housing reflect local history, culture, the
work or lack of it. The unemployed may economy and political climate. The type,
feel excluded, and lack of paid quality and suitability of housing have an
employment has been shown to contribute important affect on health. Consider the
to poor health. distance of homes from work, pharmacies,
schools and shops.
B. POVERTY AND INCOME.
Poverty can be absolute (i.e. inadequate Transport systems are important to
to sustain health) or relative (i.e. how poor record, as they can influence people's
one person is compared to another). In access to services, social support networks
health terms, it is not only the level of and employment. Transport may also have
poverty that counts but also the gap an impact on health through accidents,
between richest and poorest. noise and air pollution.

Health inequality Social support is essential for the well

A large gap results in a big difference in being of a community. There are a number
health and life expectancy between rich of elements that need to be taken into
and poor. It is one of the most significant consideration when describing the extent
factors affecting health across the world of social cohesion in a community.
and therefore information on this issue will
be essential. Family and friendship networks provide
people with the emotional support that is
C. ENVIRONMENT fundamental to well-being. Social
The surroundings where people live and networks can be hard to describe and
work in directly affect their health. A quantify. The best way is to ask local
people. It may be possible for them to • Physical Factors - geography,
describe social networks through flow environment, community size,
diagrams, maps, drawings, stories and industrial development
drama.
• Social and cultural factors - traditions,
Migration causes disruption to a norms, beliefs, economy, politics,
population, as large numbers of people income, livelihood
move location. It is often the younger
working-age population who emigrate, and • Individual Factors – behavior
this is a loss to the population left behind
while a gain to the community they move Community organizing (Minkler and
to. Migration of workers may be daily, Wallerstein (1997))
weekly or longer. Population movements "the process of by which community
can be traumatic owing to the upheaval groups are helped to identify common
caused, especially if forced by armed problems or goals, mobilize resources and
conflict, threat of discrimination or severe in other ways develop and 3 implement
economic necessity. strategies for reaching the goals they
collectively have set.”
Marginal groups are outside the dominant
community, yet may form a distinct There are various types of Community
population themselves. Some groups, such Organization. According to Rothman an
as religious sects, travelers and gypsies Tropman (1987), categories of community
may choose to remain outside mainstream organization consist of three distinct
society. Others, such as the homeless, may models practice:
be forced into that position. Access to
health care is often more difficult for both 1. Locality Development - process-
these groups, who may have greater need oriented, creating a consensus and
for services. sense of cooperation.
2. Social Planning - task-oriented,
The opportunities for non-work social emphasizing rational-empirical
activities are signposts that can be used to problem-solving
indicate the extent of social cohesion and 3. Social Action - both task and process-
support in a community. Such activities oriented
reinforce a community's identity and the 4. Community organizing
emotional wellbeing of individuals.
STEPS IN COMMUNITY ORGANIZING:
3 FACTORS AFFECT THE HEALTH OF A
COMMUNITY 1) Problem Identification
2) Interface with Community
Destabilizing factors that can affect the 3) People Organization
health status of a community such as war, 4) Community Profile and Assessment
economic recession and natural disasters 5) Goal-setting and Formulation of
such as earthquakes, floods or drought Strategies
affect health directly through their impact 6) Implementation of Agreed Strategies
on mortality, disease patterns and lifestyle or Solutions
change. 7) Monitoring and Evaluation
8) Sustaining Gains, Addressing Emerging • Attack rate - the proportion of those
Problems who became ill after specified
exposure
EPIDEMIOLOGICAL STUDY
Case Fatality Rate
Epidemiology - study of the distribution percentage of cases that result in death. It
and determinants of diseases & injuries in measures the severity of the disease and is
human populations. proportionate to the virulence of a disease
agent.
The goal of epidemiology is to limit
disease, injury, and death in a community Notifiable Diseases reported IMMEDIATELY
by intervening to prevent or limit (w/in 24hrs)
outbreaks or epidemics of disease and
injury

RATES
Rate is the number of events in a given
population over a specific period or at
given point in time. An example of rate
would be birth rate, mortality rate and
Notifiable Diseases reported WEEKLY
morbidity rate.

To determine the existence of an outbreak

during a particular time at a particular
place.

Rates can be expressed as crude or

specific. Crude rates use total population "zero-case reporting" policy which means
as the denominator (e.g. crude birth rate, even if a community has no reported case
crude death rate). of any of the notifiable diseases or events,
the health workers still have to report it as
"zero case".
Birth rate average annual number of births
during a year per 1,000 persons in the LIFE SPAN vs LIFE EXPECTANCY
population at the mid year. aka Crude
Birth Rate (The dominant factor in Life span - refers to the number of years a
determining the rate) person lives,

Morbidity rate Life expectancy - refers to the numbers of

years a person is expected to live from a
• Incidence rate - number of new cases
specified starting point.
of a disease in a population at risk in a
given time period. • DALE - disability adjusted life
• Prevalence rate - total number of expectancy
cases of disease existing in a • HALE - health adjusted life expectancy
population.
SURVEYS undergoes at least six stages of change or
transformation.
Survey is a method of gathering any type
of information or data from a sample of Prochaska, Johnson, and Lee (1998)
individuals. By sample it is meant that the suggest a series of activities that have
data is only taken from a portion of the received empirical support, which help
total population under study. individuals progress through the stages:

The National Household Targeting System 1. Consciousness-Raising increasing

for Poverty Reduction (NHTS) is a data awareness of the causes (providing
bank and an information management sys educational materials, confrontation,
tem which identifies who and where the media campaigns, feedback, etc.)
poor are in the country.
2. Dramatic Relief producing an
CENSUS emotional experience which is
followed by a reduced affect if some
A Census is the opposite of a survey It is action can be taken (personal
the counting of data gathered from the testimonies, media campaigns, drama)
entire population. It is a regularly occurring
and official count of the human population 3. Self reevaluation inviting individuals
certain local administrative unit. to make cognitive and emotional
assessments of their self image (clarify
The agency that conducts the Census is values, provide healthy models, using
the National Statistics Office imagery)

BEHAVIOR CHANGE 4. Environmental reevaluation

assessments of how the presence or
According to Bandura (1986), people's absence of a behavior might impact
behaviors are driven by external factors one's social environment
and not by inner forces. (documentaries, personal stories,
family interventions)
In his Social Cognitive Theory, Bandura
explains that human functioning can be ELEMENTS OF DIFFERENT BEHAVIOR
explained by a triadic interaction of CHANGE FRAMEWORKS
behavior, personal and environmental
factors (reciprocal determinism

Another theory that explains behavior is

the Theory of Planned Behavior suggests
that behavior is dependent on one's
intention to perform the behavior.

Another framework that can explain

behavior is the Transtheoretical Model or
also known as the Stages of Change
Model. According to the theory, a person
 Prior to the enactment of the Local
Government Code, the National
Government, headed by the Chief
Executive Officer in the presence of the
President, oversees the implementation of
health programs, through the Department
of Health, down to the barangay or village
level. Health workers were hired, paid for
LESSON 3 and supervised by the Department of
Health Leadership and Governance Health.
The Philippine health care system is a
devolved health system. A devolved set up A municipality or city has a Municipal or
is also referred to as “decentralized". City Health Officer who heads the Main
There at least 4 levels of administrative Health Office in the local government unit.
division. Each level is also referred to as The staff of the Health Office includes :
local government unit (LGU). public health nurses
• midwives
The President of the Republic being the • medical technologist
over-all Chief Executive oversees these • dentist
administrative regions. • pharmacist
• Province • other paramedical support staff
• City •
• Municipality Midwives would manage the Barangay
• Barangay. Health Stations.
Barangay health workers working as
Autonomous Regions - special volunteers in each barangay.
administrative division: At the Provincial Level, the Provincial
• Cordillera Autonomous Region Health Officer takes charge of the
(CAR) Provincial Health Office and the Provincial
• Autonomous Region for Muslim Hospitals.
Mindanao (ARMM).
Pre-Devolution Health System in the
Philippine Local Government Philippines

Implementation of Decentralization
began in January 1993 with the transfer of
funding, facilities, and staff to some 1600
Local Government Units (LGUs), as
specified in the 1991 Local Government
Code, Primary health care services, more
than 600 hospitals, other health facilities
and approximately 46,000 health
personnel were devolved.

In Decentralization, Health workers no

longer report to the Department of Health
A 1984 World Bank review analysis found but report to their corresponding local
the Philippine system to be excessive- chief executives. For example, municipal
excessively centralized, with fragmentation health workers report to their Municipal
and duplication between central and field Mayor being the over-all local chief
units, and weak linkages be-tween rural executive. Provincial health workers report
programs and centrally run disease specific to the Provincial Governor. Chiefs of
campaigns. Some adjustments Some hospitals of provincial and district hospitals
adjustments were made in response, but report to the Governor except the chiefs of
Decentralization and Health in the hospitals of facilities retained by the
Philippines and Indonesia: An Interim Department of Health. They are also
Report 4 a comprehensive 1993 review referred to as Regional Hospitals since they
pointed to worrisome features of the report to the Regional Director of the
health scene Regional Office of the Department of
• sizable mortality differentials and Health.
trend reversals in some regions
• poor nutritional status in low Health devolution in 1991 has brought
income households about massive changes in the structure of
• slow fertility decline the public health system. In terms of scope
• and low levels of consumer of health personnel, finances, facilities and
satisfaction with government responsibilities devolved to LGUs, the
facilities" (Herrin, et. al., 1993). Philippine decentralization of health
services is one of the most radical in the
Post-Devolution Health System in the developing world.
Philippines
A large part of the devolved health
services is borne by provinces and
municipalities, the latter having no prior The leadership and governance of health
experience with health decentralization. systems, also called stewardship, is
arguably the most complex but critical
• Provincial Governments - responsible building block of any health system. It is
for medical, hospital & support about the of the government in health and
services. its relation to other actors whose activities
impact on health. This involves overseeing
• Municipal governments - responsible and guiding the whole health system
for administration of Primary Health
Care & other National Programs Field
services

• City Governments - responsible for

Health offices, City Hospitals, in highly
urbanized cities (except Nat'Capital
region)

• Barangay Governments - responsible

for the maintenance of RHU & BHS
facilities

While LGUs gained significant powers and

responsibilities in the area of health As shown in the figure taken from WHO,
service delivery, various issues and Leadership and Governance is the "wheel
problems came out, among them financial in the middle of the wheel". It drives the
constraints like the inadequacy of the IRA rest of the building blocks. Without
and its skewed distribution, health leadership and governance, the rest of the
personnel issues, lack of local prioritization building blocks won't work.
for health, local competence on health,
etc. Some of the problems The standards of the health system is it has
the capacity to provide equitable access to
According to the(WHO),Leadership and essential quality health services, provide
governance is an essential part of a health financial risk protection and consequently
system. It is one of building blocks of a can produce better health outcomes for
health system as identified by the WHO. the community increasing their levels of
health above what is expected.
The other five building blocks include:
Health Human Resource, Access Medicine This has huge implication on a devolved
and Technology, Health Service Delivery, health system wherein Leadership and
Health Information and Health Financing. Governance falls largely in the hands of
It is important that these 6 building blocks political leaders who are not necessarily
are established, strengthened and health proficient
monitored in order for a health system to
produce better health outcomes especially Local Health Board
among the most vulnerable groups. mandated by the Philippine Republic Act of
7160 aka: Local Government Code of 1991
 of local appropriations for public
By law, the following should be members health purposes
of the Local Health Board:
o Consistent with the technical &
A. Provincial Health Board administrative standards of DOH ,
• Headed by Governor as Chairman create committees, personnel
• the Provincial Health Officer as vice- selection & promotion, bid & awards,
chairman grievance & complaints, personnel
• the Chairman of Committee on Health discipline, budget review, operations
of the Sagguniang Panlalawigan review & similar functions.
(Provincial Council) as representative
from private sector or According to DOH standards and by law, a
nongovernmental organizations. local health board must meet at least once
a month or as often as necessary.
B. City Health Board Recently, innovations have been
• Headed by City Mayor as chairman introduced such as expanding the local
• City Health Officer as vice-chairman health board to include other important
• the Chairman of Committee on Health stakeholders and replicating the health
of the Sagguniang Panlalawigan (City board at the barangay level (barangay
Council) as representative from health board) in order to increase
private sector or non-governmental ownership, engagement and accountability
organizations. of barangay officials when it comes to
community-based health initiatives and
C. Municipal Health Board programs
• headed by Municipal Mayor as
chairman The process of change can be difficult and
• Municipal Health Officer as vice- will require the engagement of different
chairman stakeholders but the process has to start
• the Chairman of Committee on Health somewhere and it begins with the leader.
of the Sagguniang Panlalawigan
(Municipal Council) as representative I. The leader recognizes the problem
from private sector or non- either through personal observation or
governmental organizations. through feedback from the
community. The leader then decides to
Functions of the Local Health Board make a personal response.
o to Propose to the sanggunian
(Council) concerned in accordance • Field visits & community assemblies
with standards & criteria set by DOH • Situational Analysis / Community
(annual budgetary allocations for Diagnosis
operation & maintenance of health • Problem Tree Analysis / Casual Loop
facilities & services w/in municipality, Analysis/ Inter- relationship diagraphs
city, or province)
II. The leader formulates a vision that is
o to Serve as an advisory committee to an anti-thesis to the recognized
the sanggunian (Council) concerned problem.
on health matters such as application
 • The vision comes in the form of a information is also referred to as
solution to the problem or the desired indicator.
state of reality which can be acquired
once the problem is resolved. least three types of indicators to be
monitored:
• The vision can guide the action plans
which contain the activities and Input Indicator measures resources
strategies that can lead to the invested for a particular strategy or
accomplishment of the vision. activity. Examples: number of health
workers deployed, budget in pesos,
III. The leader consolidates his or her number of eligible participants.
resources, both internal and external,
that can help achieve the vision. Process Indicator measures ways in which
the activities and strategies are conducted,
A technical way of consolidating resources An example would be error rates.
is to do inventory of one's strengths,
weaknesses, opportunities and threats. Output Indicator measures the
quantifiable end-results of the strategy or
Also known as a SWOT analysis, intervention including the efficiency of
identification of SWOTs is important production of the results. Examples:
because they can inform later steps in number of patients seen, number of
planning to achieve the objective. children immunized, length of hospital
stay, etc.
Users of SWOT analysis need to ask and
answer questions that generate V. The leader constantly communicates
meaningful information for each category the vision with the community and
(strengths, weakness- es, opportunities, regularly gets their feedback.
and threats) to make the analysis useful
and find their competitive| advantage. Communication is very important
especially in community organizing and
mobilization. It can be both a source of
tension and a source of solution for the
challenges that confront the community
members.

Communication is simply defined as the

process of transferring information from
one person or place to another.

In the process of Communication, the

following elements are involved:

IV. Monitoring and evaluation is an 1. Sender - it is the person that transmits

integral part of the change process. It the message
provides information on where one is
in relation to the goal. This
 2. Receiver - refers to the intended Peterson and Hicks (1996) suggest steps in
person who receives and interprets how to do coaching by leaders. In their
the message book, "Leader as Coach", they suggest
strategies that target common
3. Message - it is composed of words or development barriers:
symbols convey the idea being
transmit- ted by the sender. It can be
verbal or non-verbal. 1. Forge a Partnership: build trust and
understanding so people want to work
4. Channel - It is the method or medium with you. With trust, people will be
by which the message is transmitted. more willing to hear and act on what
you have to say. With understanding,
5. Context - It is the setting or situation you will know what matters to each
in which the communication takes other.
place, defining the message and
process of transmittal. 2. Inspire Commitment: building insight
and motivation so people focus their
6. Noise - It refers to anything that energy on goals that matter. You
interferes in the transmittal of the cannot motivate people directly, but
message. you can achieve commitment to
development when people
When the receiver sends a response understand themselves and the
feedback back to the sender, the response personal payback from working
is called a feedback toward organizational objectives.

Communication is key especially in 3. Grow Skills: build new competencies

planning and implementing strategies that to ensure people know how to do
can improve the health outcomes of the what is required. When you know
community. what the person needs to develop,
your task is to help them find the best
VI. A leader ensures that the skills and ways to acquire those new skills.
knowledge are transferred to others in
order to ensure sustainability of 4. Promote Persistence: build stamina
interventions and bigger ownership of and discipline to make sure learning
the programs by the people. lasts on the job. People require daily
effort to change old habits and put
Leaders beget leaders. It is important that new behaviors into action. You can
leaders must be able to form another help people persist until their new
generation of leaders that can continue or behaviors be- come natural.
if not even improve on what has been
initiated. The transfer of skills and 5. Shape the Environment: build
knowledge, even values and ethics, is very organizational support to reward
important. One way of transferring these is learning and remove barriers. Change
when leader mentors or coaches other is easier and the results last longer
people, especially those who have the when the organization's values and
potential of becoming leaders. rewards are aligned with coaching and
development.
 One must do both but according to
American writer Warren Bennis, "failing
organizations are usually over-managed
and under-led."

The world today is wanting for genuine

leadership, leadership that is grounded on
values and ethics.

In community health where leaders

together with their community members
initiate the change process, it is important
that leaders lead "from the heart", guided
by the vision that has been built together
In the 1980's, John Whitmore, along with with the community.
Alan Fine and Graham Alexander,
developed the GROW model in coaching. Values are manifested in action and by the
GROW stands for Goal, Reality, Options, decisions a leader makes. After all "when
Will. your values are clear to you, making
decisions becomes easier" according to
1) Establishing the GOAL - the goal can Roy E. Disney.
either be a technical problem that
needs to be solved or a behavior that
one must achieve or acquire.

2) Examining the Current REALITY the

individual must be able to de- scribe
what is happening at the moment
especially relative to the goal that is
previously identified.

3) Exploring OPTIONS - one must

determine what are the possibilities
that can be done in order to achieve
the goal.

4) Establishing the WILL - knowing what

to do may not be sufficient. The key to
accomplishing the goal is to commit to
achieving the goal. The person must
be motivated enough to see it
through.

Leadership is "doing the right things"

which is different from Management
which is doing things right"