Chapter 9 NURSING INTERVENTIONS FOR COMMUNITY HEALTH AND DEVELOPMENT Luz Barbara P. Dones INTRODUCTION The World Health Ocganization's (1978) definition of health emphasizes not only the prevailing pl1ysical and mental conditions of the people and the community. It also considers the political, economic, social anrl cu Jtucal dimensions that affect their living conditions and quality of life. In Lhis context, the interventions of the nurse cannot be limited to actions geared towards the reduction of mortality and morbidity. Community health nursing interventions necessarily ca JI for improvements in the standards of living and quality of life of the people and Lhe community. The WHO definition of health, therefore, clearly makes a stand on the link between health and developmen t. It implies that a healthy population is a moving force for economic growth of the community. Consequently, marked improvement in the economic conditions of the people will enable them to enjoy a sustained level of health and wellness. In the health development process, the Alm. a Ata Declaration (1978) stresses two important concerns in addressing he. al th issues in the community. The fast concern is the 11eedfo1· un integmced approach in solving health problems. Communily health needs and problems are not solved by simply inducing changes in personal and group attitudes and behavior. lf one e Kpects lasting and sustainable solution, reforms have to be canied oul wi U1in U1e health care delivery system and the larger socio-economic and political system. The second important concern is the need for enhanced capabi/ityfor greater parlicipalfor1 cmd inuolucmcnt of the people in hca/rh efforts includi11g policy making and influencing decisions. Often, U1e people most affected by the problem feel helpless simply because tl1ey do not believe they have the power to change their situation. In other words, community health nursing interventions must focus on providing health-rela ted interventions to improve the health status of the population and enhancin g the capability of the communi ty to manage its own health. COMMUNITY COMPETENCE AS OUTCOME OF COMMUNITY HEALTH NURSING INTERVENTIONS Community competence is defined as tl1e ability of tbe communi1y to (a) collaborate effectively in identifying its problems a_nd needs; (b) achieve a working consensus on goals and priorities; (3) agree on ways and means to implement the agreed. upon goals; and (4) collaborate effectively in the required actions to achieve goals and priorities. (Cotb·ell, 1976; Hawe, Degeling and Harl, 1990; Wass, 2000) It is very much linked to the concept of community empowerment (Minkler, 1991; Wass 2. 000) where 223 