Rural

Health
Unit I - CSFP
Health Institution Management Analysis
In partial fulfillment of the
requirements in
NRS 204

Joy April M. De Leon, R.N.

Submitted to:
Dr. Debbie Q. Ramirez

I. Introduction

Pampangas government health facilities in the province include 1 Provincial Health Office, 2
City Health Office, 9 Distirict Hospitals, 41 Rural Health Units and 5 RHUs for San Fernando,
324 Barangay Health Stations and 1 Community Hospital. Private Health Facilities include 10
Secondary Hospitals, 1 Tetiary Hospital and 40 Private Hospitals. RHU I CSFP, which is under
the City Health Office is located in Sto. Rosario (Poblacion), City of San Fernando, Pampanga.
It includes 9 barangays namely Dolores, Sto. Nino, Magliman, San Jose, Sto. Rosario, Lourdes,
San Juan, Juliana and Sta. Teresita. There are 12 health stations and 1 birthing station located
with the said barangays.

II. Mission, Vision, Goals

Vision: A supportive and committed LGU for trained and competent health personnel to provide
quality service towards the attainment of healthy communities for all Fernandinos

Mission: The City Health Office shall make Fernandinos to attain a level of health that will allow
them to lead a socially and economically productive life with longer life expectancy, low infant
and maternal mortality and less disability through strengthened primary health care measures that
will guarantee accessibility, affordability and availability to everyone especially to marginalized
group and poorest of the poor to quality health service.

Responsibilities:
City Health Office

Responsible for formulating program implementation guidelines and rules and regulations in
order to assist the LCE in the efficient, effective and economical implementation of health
service program geared to implement health-related projects and activities;

Responsible for the formulation of measures in carrying out activities to ensure the delivery
of basic services and provision of adequate facilities relative to health services provided
under Sec. 17 of the LGC of 1991;

Responsible for the development of plans and strategies and upon aproval thereof by the
LCE, implement the same, particularly those which have to do with health programs and
projects which the LCE is empowered to implement and which the SP is empowered to
provide under the LG Code of 1991;

Responsible for the formulation and implementation of policies, plans and projects to
promote the health of the people in the city;

Responsible for advising the LCE and the SP on matters pertaining to health;

Responsible for the execution and enforcement of all laws, ordinances and regulations
relating to public health;

Responsible for the recommendation to the SP through the Local Health Board the passage of
such ordinances as deem necessary for the preservation of public health;

Responsible for the recommendation of the prosecution of any violation of sanitary laws,
ordinances or regulations;

Responsible for directing the sanitary inspection of all business establishment selling food
items or providing accommodation such as hotels, motels, lodging houses, pension houses,
and the like, in accordance with the Sanitation Code;

Responsible for the conduct of health information campaigns and render health intelligence
services;

Responsible for the coordination with other government agencies and non-government
organizations involved in the promotion and delivery of health services.

Rural Health Units

Responsible for administering rural health services;

Responsible for providing medical and medico-legal care;

Responsible for providing epidemiological and environmental health services;

Responsible for providing continuing education in matter of public health;

Responsible for giving trainings and attend medical missions;

Responsible for providing field medical services medical, dental, nursing, laboratory,
environmental sanitation and midwifery or barangay health services;

Responsible for monitoring and inspection of water supply sanitation, excreta & sewage
disposal, food establishment sanitation, solid-waste mgmt., insect & vermin control, public
places sanitation, industrial hygiene, market & slaughterhouse sanitation, health education on
sanitation and nuisance abatement;

Responsible for providing Social Hygiene Services (medical & laboratory, health education,
records, supply & materials, case finding and contact tracing);

Responsible for providing special program services (population devt. program, population
support & advocacy, pre-marriage counselling, community organization, population data
mgmt., research & evaluation, family planning program, service delivery, monitoring &
evaluation and nutrition program).

III. Organizational Structure

Rural Health
Physician
Dentist

Med Tech
Public Health
Nurse

CHN
Dolores N

CHN
Magliman

MW
Dolores S

MW
San Juan

MW
Sto. Nino N

MW
Juliana

CHN
Sto. Nino S

MW
Lourdes

CHN
Ponduan

MW
San Jose

MW
Sto. Rosario

MW
Sta. Teresita

Rural
Sanitary
Inspector
Dental Aide

Lab Aide
Utility

IV. The Nursing Service/Unit

a. Number of People employed under Nursing Service

1 Public Health Nurse

4 Community Health Nurses

8 Midwives

b. Brief Description of the roles/position of each member of the unit

Public Health Nurse

1. Identifies health needs in the community and creates and facilitates programs.
2. Conducts evaluations of referral information and conducts home visits to determine clients
needs including physical assessment and interview to determine current and past health
problems.
3. Develops, implements, and evaluates an individualized plan of care based on assessment.
4. Implements plan of care by performing skilled nursing services and on-going evaluation.
5. Instructs families in home care procedures to facilitate clients return to independence.
6. Provides comprehensive case management and coordinates services provided through a
multidisciplinary approach collaborating extensively with multiple community agencies.
7. Coordinates the services of home health aides, physical therapists, occupational therapists,
and speech pathologists according to the patients needs.

8. Interprets health screening findings to the family and makes appropriate referrals, utilizing an
up-to-date list of resources in the county.
9. Contacts local health providers and community agencies to make referrals.
10. Conducts health assessments in clinics, including conducting physical assessments, obtaining
blood pressure, temperature, measurements, and other data and developing information on
health history, diet history, and family health status. Administers immunizations and TB and
STD medications, educates clients on potential side effects, and monitors for adverse
reaction. Reads and interprets lab reports, administers urine pregnancy tests, and performs a
variety of related procedures in clinics.
11. Provides education to clients and families relative to parenting, nutrition, health care,
prenatal care, breast feeding, safety, substance abuse, communicable diseases, and other
subjects as needed by client.
12. Provides home visits and health assessments for new born infants, pregnant women and other
clients.
13. Investigates and monitors reports of communicable diseases such as measles, hepatitis,
sexually transmitted disease, and tuberculosis.
14. Coordinates efforts with physicians, school personnel, and others regarding spread and
treatment of the disease. Provides health care services, instruction, and information to clients
in compliance with related public health laws.
15. Reviews documentation in charts on a periodic basis to ensure compliance with rules and
regulations for the specific program area.
16. Initiates, maintains, and updates various records and prepares reports of work activities,
communicable diseases, and other subjects for physicians and departmental administrators.

17. Participates with other members of the community in assessing, planning, implementing, and
evaluating health services including the promotion of a broad continuum of primary,
secondary, and tertiary prevention of illness.
18. Represents the department on various advisory committees throughout the county,
determining community needs and assisting with goal implementation.
19. Represents the department at various community activities related to the promotion of health
and the prevention of disease.

Community Health Nurse/Midwife

1. Conduct primary medical care management and treatment.

2. Conduct expanded program on immunization services on infant under 15 months old.
3. Conduct adult immunization program (pregnant, senior citizens, city hall employees and other
attached agency employees)
4. Provide pre and post natal consultation in the barangay health station
5. Provide family planning counseling services among women of reproductive age.
6. Conduct case findings among patient with symptoms of tuberculosis and follow up activities
on tuberculosis contacts.
7. Implement barangay nutrition committee activities in every barangay.
8. Provide nutritional counseling to pregnant, post partum and malnourished children.
9. Implement philhealth primary care benefits.
10. Prepare and update profile of philhealth members and dependents

11. Accomplish and consolidate reports, clinic workloads and other special reports on a daily,
monthly, quarterly, annual basis.
12. Supervise and monitor barangay health workers and community health team.
13. Conduct surveillance and report notifiable diseases emerging and re- emerging disease.

c. Type of Duty Hours / Schedule of Work Shift

Monday to Friday 8am to 5pm

d. Type of Nursing Care Modality Case Management

Case management promotes continuity of care from hospitalization through outpatients' clinics
and from there to the internal environment. It attains certain goals of improvement in patient
satisfaction.

Its main purpose is to integrate quality and cost through total care management. It permits the
supervision and evaluation of patient care, assuring a wide scope of the services according to
his/her needs with appropriate use of the resources. Its starting point is an interdisciplinary team,
which translates into a collaborative model, and interdisciplinary care, which aims at turning care
into a more human affair. It transcends specialties in such a way that all the members of the team
participate and collaborate in the achievement of a common goal; where the specific and relevant
needs of the patient are considered as priorities.

Moreover, case management focuses its practice in high risk and high cost populations, that
represent the greatest part of expenses with health in countries.

e. Leadership Style - Transformational

Transformational leaders encourage the personal and professional development of the nurses
they manage by promoting teamwork, emphasizing self-esteem and urging employees to
participate in the establishment of hospital policies and procedures. The PHN relies on a positive,
charismatic approach to managing employees. The PHN focuses on strong communication skills,
confidence and integrity. Instead of issuing orders and expecting automatic compliance,
transformational leaders explain the "how" and "why" of procedures in addition to helping nurses
understand the RHU's vision. They use empathy to understand their employees' needs and
motivations, using this insight to tailor their management and communication style to individual
employees.

V. In-service Staff Development Program

Cold Chain

EPI Midlevel/Reaching every Barangay

EPI Disease Surveillance

EPI Basic Skills

IYCF

IMCI

CEmONC

BEmONC

b. How often is it done?

It is done every 6 months.

VII. Quality Awards/ Recognition of the Institution

Best Rural Health Unit in 2012

2. Strengths and Weaknesses

Strengths

Rural people know rural issues and are creative in solving their problems

Committed primary care physicians

Employees dedicated to their community's needs

12 Barangay Health Stations for 9 barangays

Collaborative relationships among providers

Weaknesses

Lack of people or manpower in the community especially barangay health workers

There is a high risk of diseases because of the big population

Lack of supplies from the department

Lack of modernized information system technologies

3. Conclusion
Rural health units are the key to deliver health care to the people in communities. Management
of the public health nurse as well as the rural health physician is a crucial factor into achieving
the goals of each programs rendered by the unit. Case management is the nursing modality used

by the nurses in addressing the needs of the citizens, wherein proper care and focus is provided
to the individuals. The work of the PHN with regards to the management is more of a
supervisory role and a transformational type of leadership. The PHN is very particular of the
services that the nurses provide for the community. With supervision, she still is able to enhance
or develop the personal development and achievement of each of her subordinates.

4. Recommendation
Innovative approaches in health care can enhance the health of rural populations and foster
economic development within communities. Managing a barangay health station involves
entrepreneurship, perseverance, a network of knowledgeable individuals, and a community in
need. In moving toward improving local healthcare access, communities can begin to create an
environment which attracts and supports healthcare providers. The community should be open to
exploring a variety of healthcare service models to extend services to the entire population.
Combining current rural programs with a creative approach to health care can lead to increased
access and availability of services. Moreover, additional recruitment is necessary to attain the
RHUs objectives. Taken together, the recommendations lead to notable progress in stabilizing
and improving rural health care systems and positions rural health providers to make the
contributions needed to successfully meet health goals and provide citizens with the health care
improvements they expect and need.

5. References
More PK, Mandell S. (2007). Nursing case management: an evolving practice. New York:
McGraw-Hill