Tuesday, December 01, 2015

COMMUNITY HEALTH PRACTICE (CHP) RECOMMENDATIONS by the Faculty of Health Sciences - University of Bamenda

Dean FHS

Dr MFONFU Daniel
Independent Researcher
Tel: +237 677601207
Email: dmfonfu@yahoo.com



Goal of community Health Practice by the Faculty of Health Sciences (FHS):
The practical training course in community Health Practice has as objective to familiarize the 2nd year medical students with the exercise of establishing the diagnosis of the health situation of the community as stated in the ‘Academic programmes of the Faculty of Health Sciences, University of Bamenda’

a)      Collect data from households using questionnaires – on environmental sanitation and on vaccination status of children 0-23 months
b)      Educate the population on some identified factors that could cause health problems while on the field
c)      Analyse data collected
d)     Determine health needs and problems
e)      Propose solutions and strategies to solve needs and problems identified

20 teams will be constituted by the 59 students of MD2 – 19 of 3 members and 1 team of 2 members. Three Groups of students will be formed according to the three zones of Mulang Health Area – Mulang, Musang, and Ngomgham. The sites will be selected by balloting. The groups will be formed after the choice of sites. Each group will elect a group leader.  Equity will be expressed in, among others, gender and first official language (English and French).  There will be equity in formation of teams and the election team and group leaders. The leaders will ensure that discipline reigns during the CHP period and that all logistics are available.The team leaders are accountable to the group leaders while the group leaders are accountable to the lecturers.

Criteria for the choice of sites
Estimation of surface area that could have enough sample size

A mobiliser is a person living in the quarter, who has a good knowledge of the site; who has been working as a mobiliser in other health activities; who will lead and introduce the students to the families and assist the students in interpreting the questions to the respondents in case they don’t understand; and who will provide security to team.

Movement of teams in the sites
Each of the 20 teams will be accompanied by a community mobiliser.
Divide sites into about tow accessible sections; Select the section where to start. Ensure that the sample of 10 households is obtained from each of the sections. The only criterion for the selection of a household in a compound is the presence of children from 0-23 months in the household. Each team will move from compound to compound collecting data from a selected household with children 0-23 months in the compound.A compound is a collection of households in an area with the same landlord. A compound consisting of a hotel will not be chosen.In a compound consisting of a storey building only one household with children 0-23months will be chosen. Choose only one household in a compound.10 households will be selected each day. A household is defined as a social unit comprising people living in the same house, with the samefamily head, and sharing food from the same pot. One household is chosen in the compound because the compound may have the same environmental characteristics for all the households.

i)                    Questionnaire for the environmental sanitation
ii)                  Questionnaire for the collection of data on vaccination status
iii)                Manual synthesis form for the synthesis of environmental sanitation questionnaire
iv)                Manual synthesis for the compilation of data on vaccination status
v)                  Software for the zone synthesis of data from the manual synthesis of sitesof environmental sanitation
vi)                Software for the zone synthesis of data from the manual synthesisof zone of vaccination status from sites
vii)              Health Area software for the synthesis of zones for environmental sanitation
viii)            Health Area software for the synthesis of zones for evaluation of vaccination coverage rate.

Topics covered by questionnaire:
The topics of Environmental sanitation and Expanded Programme of Immunisation (EPI) taught in the first year of medical studies as stated in the Academic programmes of the Faculty of Health Sciences, University of Bamenda’.

Data collection on '03 - 04 June 2015:
Collection of data from households was done using questionnaires – on environmental sanitation and on vaccination status of children 0-23 months for two days.
This was done by observing the environment, and interviewing a knowledgeable respondent in the house (father, mother, and caretaker).
The Lecturer will collect data of the previous month from the principal health centre of the health area on the main diseases diagnosed and the routine EPI in order to compare the data and vaccination coverage rate with that found in the community.

Health facilities in the health areas
Identify and list the private approved health facilities in the sites, approved private pharmacies; and traditional practitioners, and patent medicine scores.

Compilation of data from the Zones:Compilation of data collected by the team is done on the same day of the data collectionin class in the afternoon as from 13:00 using the manual synthesis form. The group synthesis will be done using the softwareconceived for the purpose. Each group will choose a secretary versed in computer science and having a good performing laptop.
The synthesis of the most frequent diseases/health problems will be done in a plenary sessionto identify them so that all the teams and groups will have the same diseases, about 5 of them; the same is done for incapacitating or disabling diseases; and health insurance.
The group syntheses are supervised and approved by the Lecturer.
Each group submit the electronic copy of the approved group synthesis to the Lecturer.

Writing of group reports
Three group or zone reportswill be written according to Mulang, Musang and Ngomgham. Report writing begins on the first day of the community health practice. The reports are written according to the format given by the Lecturer and using the tables in the zone synthesis software in the ‘sheet of Tables Graphs) in environmental sanitation and in the sheets of ‘Graphs and tables’ in the zone vaccination synthesis.

Presentation of group reports
Group reports are presented using power point in class. The Dean, who is the Head of the Department of Public Health, presided the group presentations.
Each group handed in a hard copy and an electronic copy of the report to the Lecturer.

Synthesis of Health Area data
Each group submitsa copy of the software for the zone synthesis to the Lecturer so that he could make the health area synthesis.
Using the Health Area synthesis software: copy the TOTAL (YES/NO) in the ‘Grand Total’ Sheet of the environmental sanitation software of the zone and paste them in the respective zone of the Health Area software, starting from zone1. Copy the GRAND TOTAL from the 'Table' sheet of vaccination zone synthesis software and paste in the corresponding Zone sheet of the health area synthesis software starting from zone1 Thesesyntheseswere discussed and corrected with students in class. The graphs of this health area synthesis and pictures taken by students in the field are used to write the health area power point presentation that isdisplayed during the meeting with the Administration and Community representatives.

Assessment of students:
Attendance of each student at each activity is registered by a signed roll call; each absence will cost a student 5 points. Only justified medical certificate may be admitted by Faculty administration. Complete absence will mean 0 marks.
The students will be evaluated on the quality group reports and group presentations by the Lecturer.
The evaluation will be based on comments made by Professors and Lecturers during the power point presentation by the group representatives.

Questionnaires – to be produced by the lecturers/the FHS
Pen – to fill the questionnaires and make notes on some observations made in the field
Camera – to snap good and bad findings
Laptop – to fill in data for synthesis using the corresponding softwares and to type the reports
Exercise book – to note some observations while in the field
Umbrella in case it rains
White gown

The university bus will collect students from the campus at Mile 3 at 07:00 to Mulang Health Area through Foncha Street. The teams will be dropped at points in their various zones near their sites and will be picked up by the bus at about 12:30 back to campusfor synthesis. The teams will meet their mobilisers at points indicated. Communication will be by phone.

Supervision of teams in the field
The supervision of teams in the field will be done by the Lecturers and the Dean; the communication channel will be by mobile telephone.

  • The Dean requested and obtained authorization from the Divisional Officer of Bamenda II by the letter no 29/06/3100/5/445 of 27 of May 2015 to carry out the community health practice and diagnosis in Mulang health area.
  • The  Dean requested and obtained a bus  from the vice Chancellor of the University  of Bamenda
  • The Dean wrote the invitation for the meeting for the presentation of the results of the CHP to Administrative & Community Representative; these invitations were distributed by Dr Mfonfu Daniel

·         Mobilizers facilitated the work
·         Mobilizers taught us how to interact with people of the community
·         The questionnaires made things easier
·         The excel program for synthesis made the work easy
·         The lecturer was caring about the students on the field
·         The presence of the Dean reinforced the seriousness of the exercise
·         The vaccination coverage rates amongst children 12-23 months were very good for the antigens evaluated
§  Most houses have pipe borne water supply which they say hardly stop flowing
§  There is a beautiful integrated health centre that coordinate health activities in the health area 
§  Some people separate their waste into organic and inorganic.
§  Very few people buy drugs from hawkers.
§  Many people declared that they sleep under a mosquito net.
§  The road bellow Foncha through Mulang is being constructed
§  The Students educated the population on some identified factors that could cause health problems while on the field
§  No identification of any vaccine preventable disease according to the EPI program of Cameroon while on the field.
§  In some restaurants, hand-washing is done with water flowing from a container.
§  The school  bus aided us in transportation
§  The community collaborated and were welcoming

§  Community health practice of the area coincided with the day of IWC on the first day of CHP making it difficult to find the number of children required
§  The road from La chance bridge through Musang  zone including the Mulang Health Centre, to Ngomgham is very bad thus reducing accessibility to the Mulang HC
§  The target 0-11month used as denominators for the calculations vaccinations  rates include children who are either above or below the recommended age groups
§  Some water closet toilets are directed to the stream; this practice can cause water borne diseases in people downstream - such as cholera, typhoid, hepatitis A, and etc.
§  Very many people do not believe in protecting their body privacy because most simple pit latrines are poorly constructed with bad slabs, poor or no walls, without roofs &lids for squatting holes, providing a fertile ground for fly multiplication and consequently disease transmission.
§  Poorly constructed wells & springs with poor hygienic conditions are still being used in many households
§  Some people throw waste in streams.
§  Some septic tanks are poorly constructed while some are directed to the stream.
§  In most restaurants, hand-washing is done with water put in a single bowl.
§  Most piggeries and poultries are very dirty and have offensive odour.
§  Some people do not properly use their mosquito nets; some use it as window blinds.
§  Building in the Mulang river bed thus narrowing it,
§  One bus carrying students to the field bring the second batch very late in the field when most parents would have left the house

  • The days of data collection on the field should not correspond with that of Infant Welfare Clinic at the Principal Health Centre
  • In the spirit of multi sectorial development of health:
§  The Regional Delegation of Public Health (Ministry of Public Health) should stop the selling of manyanga (palm kernel oil) in health facilities.
§  The Ministry of Animal Husbandry should train farmers to keep piggeries and poultries clean and inoffensive.
§  The Ministry of Agriculture and Agricultural Schools should promote organic farming using the large amount of organic waste generated from our households and markets.
§  The Ministry of Public Health, WHO and UNICEF should establish the proportions for target populations to be used as denominators in EPI.
  • Let us promote organic agriculture
§  Let us separate household waste and waste from the markets into organic and inorganic;
§  Let us take the organic waste to our farms and use it as organic fertilizer.
§  Setting up an industry for producing organic fertilizer out of these organic waste, will serve as a source of employment.
§  The Ministry of Agriculture should lead us
  • The Council Should
-          Clean the water bed of Mulang River.
-          Prevent people from building in Mulang River Bed.
-          Provide more dustbins in the streets.
-          Recruit sanitary inspectors to inspect the sanitary conditions of bars, restaurants, the environment and toilets; and provide IEC for behaviour change.
  • The FHS should inform the community by mass media well before hand of the date of community health practice to be carried out by students.
  • The University should provide 2 buses to carry the students to the field; one bus could bring them back

1.       We have tried as much as possible to present to you the results of the Community Health Practice in Mulang Health Area concerning the assessment of environmental sanitation and evaluation of vaccination coverage of children aged 0-23months.
2.       We are grateful to the community for their cooperation and welcoming spirit.
3.       We are also grateful to the mobilizers who facilitated our work by taking us exactly to houses with children of our required age range (0-23 months).
4.       We plead the information that we have provided will help us improve the living conditions of our population in Mulang Health Area at our various posts of responsibilities.
5.       We are very grateful to the school authorities for organizing this course.

Goal of presentation of results of community health practice (CHP) at Mulang health area to administrative and community authorities: 
Ø  Provide a feedback on CHP to authorities so that they could use it to give Information, Education and Communication (IEC) to  the population of Mulang Health Area in order to enhance behaviour change for the improvement of healthy environmental sanitation and lifestyle 

1.       Mr Fonguh Joseph Ngu – 1st Deputy Mayor Bamenda II Council
2.       Dr Manjo Matilda – Regional Delegate of Public Health for North West Region
3.       Tangang Fidelis A. – Representative of Government Delegate of Bamenda city Council
4.       Ndah Johnson – Representative of Chief of Mulang integrated Health Centre
5.       Akenji Rachel – Member of the Management Committee of Mulang Health Area
6.       Mbugang Michael - Member of the Management Committee of Mulang Health Area
7.       Ngang Daniel - Member of the Management Committee of Mulang Health Area
8.       Chi Simon – Focal Person for Mobilisers
9.       Dr Mfonfu Daniel – Lecturer
10.   Ms Kinyuy Solange Kiven – Lecturer
11.   Prof Kuaban Christopher – Dean of the FHS, and Head of the Department of Public Health
All the 2nd year students of 2015 participated at meeting

A selected group of students made a power point presentation of the report of the community health practice realised at Mulang Health Area by the students with the assistance of the lecturers.

Ø  All participants listened keenly to the presentation made by the students and contributed positively to the efforts made by the students and thanked the Dean for choosing Mulang Health Area. They declared that the presentation had revealed to them what they did not know and stated that they were thus armed to educate their population.
Ø  The participants requestedthe copies of the presentation so that they can use it to sensitize their population and carry out the recommendations proposed. They declared that they have found in the Faculty of Health Sciences a real partner.
Ø  The Dean promised to progressively improve on the questionnaire to include other important recent activities carried out by the Ministry of Public Health.
Ø  Recent vaccines like pneumo and rotavirus  will be included in the following years of CHP in other health areas
Ø  The Dean promised the participants the electronic copies very soon. The Dean sincerely thanked all invitees for their participation
Ø  The meeting started at 10:00am and ended at 12:00noon

Reasonsof posting this Community Health Practice (CHP) report at the internet
  •   The Dean recommended the posting of this report at the internet in order to share knowledge.
  • Community Health Practice is an activity in the curriculum of training in all medical schools in Cameroon so the FHS in the University of Bamendais sharing its technical-know-how in all its components and tools with other universities and it iswilling to provide technical assistance to other universities.
  • The Dean believes that a FHS must have an impact on the local communityin improving their environmental sanitation and life style that is why sincetook over the running of this FHS the 2nd year students have been carrying out the CHP in the different health areas of Bamenda Health.
  • The Dean believes that a FHS should contribute in improving some components of the health system
  • The dean provided both electronic and hard copies of the reports to health authorities and community representatives.
  • People of goodwill after reading this report may decide to help the health area in solving some of the problems identified.


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