COMMUNITY HEALTH

NURSING

NURSING:
 - assisting sick individuals to become
healthy and healthy individuals achieve
optimum wellness.
COMMUNITY:
 a group of people with common
characteristics or interests living together
within a territory or geographical boundary.
 Place where people under usual
conditions are found.
Community Health
 part of paramedical and medical
intervention/approach which is concerned on the
health of the whole population.
WELLNESS
 an active FIVE DIMENSIONAL process of becoming
aware of and making choices toward a higher
level of well-being. The 5 dimensions of wellness
are the PHYSICAL, SOCIAL, EMOTIONAL,
INTELLECTUAL, AND SPIRITUAL dimensions.
 HEALTH 3

“State of complete physical, mental and

social well-being, not merely the absence
of disease or infirmity”
Major contributor to the overarching goal
of poverty reduction
Modern concept
 the
optimum level of individuals, families and
communities
 DETERMINANTS OF HEALTH
4

Affected by a combination of many factors

Determined his circumstances and environment
 Itis inappropriate therefore to blame or credit the
persons state of health to himself alone because he is
unlikely able to directly control many of these factors
Knowledge of these factors is important in order
to effectively promote health and prevent
illnesses
 Factors that make people healthy or
not:
5

Income and social status

Education
Physical environment
Employment and Working conditions
Social support networks
Culture
Genetics
Personal behavior and coping skills
Health services
Gender
 PUBLIC HEALTH
6

Political
Socio-economic
Environment
Behavior
Heredity
Health Care Delivery System
 Core business of Public Health
7

disease control
injury prevention
health protection
health public policy
promotion of health and
equitable health gain
 ESSENTIAL
PUBLIC HEALTH FUNCTIONS
8

SET OF FUNDAMENTAL ACTIVITIES THAT

ADDRESS THE DETERMINANTS OF
HEALTH, PROTECT A POPULATION’S
HEALTH
AND TREAT DISEASE
 Following are essential health
functions:
9

Health situation monitoring and analysis

Epidemiological surveillance/disease prevention and control
Development of policies and planning in public health
Strategic management of health systems and services for population
health gain
Regulation and enforcement to protect public health
Human resources development and planning in public health
Health promotion, social participation and empowerment
Ensuring the quality of personal and population based health services
Research, development and implementation of innovative public
health solutions
 GLOBAL AND COUNTRY HEALTH
IMPERATIVES
10

Ongoing changes which exert a number of

pressures on the public health system
 Shifts in demographic and epidemiological
trends in diseases
 New technologies for health care,
communication and information
 Existing and emerging environmental
hazards some associated with globalization
 Health reforms
 United Nations General Assembly
11

COMMON VISION
Poverty reduction and
sustainable development in
September 2000
 Millennium Development Goals
12

based on the fundamental values of freedom,

equality, solidarity, tolerance, health, respect
for nature and shared responsibility:
 Eradicate extreme poverty and hunger
 Achieve universal primary education
 Promote gender equality and empower women
 Reduce child mortality
 Improve maternal health
 Combat HIV/AIDS, malaria and other diseases
 Ensure environmental sustainability
 Develop a global partnership for development
 OVERVIEW OF THE
PUBLIC HEALTH NURSING
13
 DR. MARGARET SHETLAND

“The philosophy of
Community Health
14

Nursing
is based on the
worth and dignity of
man”.
 Concepts
15

 Health promotion;
 Extended benefit not only the individual but
the whole family and community.
 CH nurses are generalists in terms of their
practice
 Contact with the client and/or the family
may continue over a long period of time
 The ultimate goal of
community health services
is
16

“TO RAISE THE LEVEL

OF HEALTH OF THE
CITIZENRY”
 Principles of CHN
17

 Based on recognized needs

of communities, families,
groups and individuals
 Family is the unit of service
 Must be available to all
regardless of race, creed and
socio-economic status
 Health teaching is CHN’s
primary responsibility
 PHN defined by WHO:
18

“Special field of nursing that combines the

skills of nursing, public health and some
phases of social assistance and functions as
part of total public health programme for the
promotion of health, improvement of the
conditions in the social and physical
environment, rehabilitation of illness and
disability”
 CHN defined by Freeman:
19

“Service rendered by a professional nurse

with communities, groups, families and
individuals at home, in health centers, in
clinics, in schools and in places of work for the
promotion of health, prevention of illness,
care of the sick at home and rehabilitation”
 CHN defined by Jacobson
20

“Nursing practice in a wide variety of community services

and consumer advocate areas and in a variety of roles at
times including independent practice… community
nursing is certainly not confined to public health nursing
agencies”
“Learned practice discipline with the ultimate goal of
contributing, as individuals and in collaboration with
others, to the promotion of the client’s optimum level of
functioning through teaching and delivery of care”.
 The original thrust of Public Health
Nursing:
21

“Nursing for the health of

the entire
public/community versus
nursing only for the public
who are poor”
 Standards of Public Health Nursing:
22

Public Health Nursing

 Refers to the practice of nursing in national and
local government health departments and public
schools
 It is a community health nursing practice in the
public sector
Public Health Nurses
 Refers to the nurses in the local/national health
departments or public schools whether their
official position title is public health nurse or nurse
or school nurse
 PUBLIC HEALTH NURSES
23

Leaders in providing quality health services to

the communities
First level of health workers to be
knowledgeable about new public health
technologies and methodologies
Usually the first ones to be trained to
implement new programs and apply new
technologies
 THE PHILIPINE HEALTH
CARE DELIVERY SYSTEM
24
 Major players of the HCDS
25

Private sector
 Largely market oriented
 Health care is paid through user fees at the point of service

 Includes profit and non-profit health providers

 Includes providing health services in

Public sector
 largely financed through a tax-based budgeting system at
both national and local levels
 health care is generally given free at the point of service

 consist of the national and local government agencies

 NATIONAL LEVEL
26

Department of Health
 Mandated as the lead agency in health

 Maintains specialty hospitals, regional hospitals and

medical centers
 Maintains provincial health teams made up of DOH
representatives to the local health boards and
personnel involved in CDC, specifically for malaria and
schistosomiasis
Philippine General Hospital
 Part of national level which provide health care
services
 LOCAL LEVEL (LOCAL HEALTH
SYSTEM)
27

Run by LGU
 Provincial government
 Provincial and District hospitals
 City/Municipal government

Health centers/RHU
Barangay health stations
 LOCAL CHIEF EXECUTIVE
28

Chaired the local health board

Function is mainly to serve as advisory body
to the local executive and the sanggunian or
local legislative council on health-related
matters
 Objective of the Health
Sector
29

Improve the general

health status of the
population
Reduce morbidity and
mortality from certain
diseases
 LOCAL HEALTH SYSTEM
(Created under RA 7160)
30
 INTER LOCAL HEALTH SYSTEM
31

System of health care similar to a district health system

in which individuals, communities and all other health
care providers in a well-defined geographical area
participate together in providing quality equitable and
accessible health care with Inter Local Government Unit
(ILGU) partnership as the basic framework.
Overall concept is clustering municipalities into Inter
Local Health Zone (ILHZ)
 Each IHLZ has a defined population within a defined geographical
area and comprises a central referral hospital and a number of
primary level facilities such as RHU and BHSs
 Importance of ILHS
32

Re-integrate hospital and public health service for a

holistic delivery of health services
Identify areas of complementation of the
stakeholders in the delivery of health services
 Stakeholders include:
 LGUs at all levels
 DOH
 PHIC
 NGOs
 Private sectors
 Communities
 Guiding principles in developing the
ILHS
33

Financial and administrative autonomy of the

provincial and municipal administrations
Strong political support
Strategic synergies and partnerships
Community participation
Equity of access to health services by the
population, especially the poor
 34

Affordability of health services

Appropriateness of health programs
Decentralized management
Sustainability of health initiatives
Upholding of standards of quality health
service
 Composition of the ILHS
35

People
 number of people may vary from zone to zone; ideal health
district would have a population size between 100,000 to
500,000 for optimum efficiency and effectiveness
Boundaries
 clear boundaries between ILHS determine the accountability
and responsibility of health service providers, geographical
locations and access to referral facilities such as district
hospitals are the usual basic in forming the boundaries
Health facilities
 district or provincial hospital, number of RHU & BHS and other
health services deciding to work together as an integrated
health system
Health workers
 right unit of health providers is needed to deliver
comprehensive health services
PHILIPPINE DEPARTMENT
OF HEALTH
36

HISTORICAL BACKGROUND
(PRE-SPANISH AND SPANISH
PERIOD)
 37

September 29, 1898

 General Orders No. 15 established the Board of Health
for the City of Manila
July 1, 1901
 Act No. 157 created Board of Health for the Philippine
Islands, also functioned as the Local Health Board of Manila
December 2, 1901
 Act Nos. 307, 308 established the Provincial and
Municipal Boards completing the health organization in
accordance with the territorial division of the islands
 Board of Health for the Philippine Islands became Insular
Board of Health
 38

October 26, 1905

 Act No. 1407 abolished the Insular Board of Health and replaced
by the Bureau of Health under the Department of Interior
 Act No. 1487 (1906) replaced the provincial boards of health
with district health officers
1915
 Act No. 2468 transformed the BOH into a commissioned service
called the Philippine Health Service
1932
 Act No. 4007 (Reorganization Act of 1932) reverted back the
Philippine Health Service into the Bureau of Health and combined
the Bureau of Public Welfare under the Office of the
Commissioner of Health and Public Welfare
 39

PHILIPPINE COMMONWEALTH AND

THE JAPANESE OCCUPATION
(1935-1945)
 PHILIPPINE COMMONWEALTH AND THE
JAPANESE OCCUPATION (1935-1945)
40

May 31, 1939

 Commonwealth Act No. 430 created the Department of
Public Health and Welfare
January 7, 1941
 EO No. 317 fully implemented Commonwealth Act No. 430
January 1, 1951
 Office of the President of the Sanitary District was converted
into RHU carrying out 7 basic health services; Maternal and
Child Health, environmental Health, CDC, Vital Statistics,
Medical Care, Health Education and Public Health Nursing
February 20 1958
 EO No. 288 effort to decentralize governance of health service.
An office of the regional health director was created in 8 regions
and all health services were decentralized to the regional,
provincial and municipal levels
 41

 1970
 Restructured Health Care Delivery System was conceptualized, classified
health services into Primary, Secondary and Tertiary
 June 2, 1978
 PD 1397 renamed the Department of Health to the Ministry of Health

 December 2, 1982
 EO No. 851 created Integrated Provincial Health Office

 April 13, 1987

 EO No. 119 transformed the Ministry of Health back to the Department of
Health
 October 10, 1991
 RA 7160 (Local Government Code) provided for the decentralization of
the entire government; DOH changed its role from one of implementation
to one of governance
 May 24, 1999
 EO No. 102 (Redirecting the Functions and Operations of the DOH)
granted the DOH to proceed with its Rationalization and Streamlining Plan.
 1999-2004

42

DEVELOPMENT OF HEALTH
SECTOR REFORM AGENDA
ROLES AND FUNCTIONS OF
DOH (Mandated by the EO
No. 102)
43
 44

ROLE
Providing technical
and other resource
assistance
 GENERAL FUNCTIONS UNDER THREE
SPECIFIC ROLES
45

Leadership in Health
Enabler and Capacity
Builder
Administrator of Specific
Services
 46

VISION
The DOH is the leader, staunch advocate and
model in promoting “Health for All in the
Philippines”.

MISSION
Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor and
shall lead the quest for excellence in health
 GOAL: Health Sector Reform
Agenda47(HSRA)
Health Sector Reform is the overriding goal of
the DOH.
 Support mechanisms will be through

¹sound organizational development

²strong policies
³systems and procedures
⁴capable of human resources and
⁵adequate financial resources
 Rationale for Health Sector Reform
48

Slowing down in the reduction in the IMR and the MMR

Persistence of large variations in health status across
population groups and geographic areas
High burden from infectious diseases
Rising burden from chronic and degenerative diseases
Unattended emerging health risks from environmental
and work related factors
Burden of disease is heaviest on the poor
 Reason for the existence of the above
conditions
49

Inappropriate health delivery system –

 shown by an inefficient and poorly targeted hospital
system ineffective mechanism for providing public
health programs on top of health human resources
maldistribution
Inadequate regulatory mechanisms for health
services
 resulting to poor quality of health care, high cost of
privately provided health services, high cost of drugs
and presence of low quality of drugs in the market
Poor health care financing and inefficient
sourcing or generation of funds for healthcare
 Framework for the
implementation of HSRA:
50

FOURMULA ONE
FOR HEALTH
 51

FOURmula ONE for Health

 implementation framework for health sector reforms in the
Philippines for the medium term covering 2005-2010.
 designed to implement critical health interventions as a single
package, backed by effective management infrastructure and
financing arrangements.

FOURmula ONE for Health

 engages the entire health sector, including the public and
private sectors, national agencies and local government units,
external development agencies, and civil society to get involved
in the implementation of health reforms.
Goals of FOURmula one for
Health
52

STARTING THE RACE WITH

THE END IN MIND:
 53

Over-all Goals:
The implementation of FOURmula ONE for Health
is directed towards achieving the following end
goals, in consonance with the health system goals
identified by the World Health Organization, the
Millennium Development Goals, and the Medium
Term Philippine Development Plan:
 Better health outcomes
 More responsive health system
 More equitable healthcare financing.
 54

General Objective:
 FOURmula ONE for Health is aimed at achieving critical reforms with speed,
precision and effective coordination directed at improving the quality,
efficiency, effectiveness and equity of the Philippine health system in a
manner that is felt and appreciated by Filipinos, especially the poor.

Specific Objectives:
 Fourmula One for Health will strive, within the medium term, to:
 Secure more, better and sustained financing for health
 Assure the quality and affordability of health goods and services
 Ensure access to and availability of essential and basic health packages
 Improve performance of the health system
Goals of FOURmula one for
Health
55

CARRYING OUT THE

GAME PLAN:
 Winning Strategies to Attain FOURmula
ONE for Health
56
Component
F1 Component No. 1: HEALTH FINANCING
 secure more, better and sustained investments in health to provide equity and
improve health outcomes, especially for the poor.
F1 Component No.2: HEALTH REGULATION
 assuring access to quality and affordable health products, devices, facilities
and services, especially those commonly used by the poor.
F1 Component No. 3: HEALTH SERVICE DELIVERY
 improving the accessibility and availability of basic and essential health care
for all, particularly the poor. This shall cover all public and private facilities and
services
F1 Component No.4: GOOD GOVERNANCE IN HEALTH
 improve health systems performance at the national and local levels.
PRIMARY HEALTH CARE AS AN
APPROACH TO DELIVERY OF
HEALTH CARE SERVICE
57
 PRIMARY HEALTH CARE
58

Essential health care made universally accessible

to individuals and families in the community by
means of acceptable to them through their full
participation and at a cost that the community and
country can afford at every stage of development
Primary health care was declared during the First
International Conference on PHC held in Alma Ata
USSR on September 6 – 12, 1978 by WHO with a
goal of “Health for All by the year 2000”
Primary Health Care was adopted in the
Philippines through LOI 949 signed by Pres. Marcos
on October 19, 1979 and has an underlying theme
of “Health in the hands of the People by 2020”
 Concept of PHC is characterized by;
59

Partnership and empowerment of the people

PHC is a strategy
 which focuses responsibility for health on the individual, his
family and the community
PHC includes full participation and active
involvement of the community
 towards the development of self-reliant people, capable of
achieving an acceptable level of health and well being
PHC recognizes the interrelationship between health
and the overall political, socio-cultural and
economic development of society
 Elements/Components of PHC
60

Environmental Sanitation
Control of communicable diseases
Immunization
Health Education
Maternal and Child Health and Family Planning
Adequate Food and Proper Nutrition
Provision of Medical Care and Emergency Treatment
Treatment of Locally Endemic Diseases
Provision of Essential Drugs
 Strategies
61

 Reorientation and reorganization of the national health care

system (RA 7160)
 Effective preparation and enabling process for health action
at all levels
 Mobilization of the people
 with the end view of providing appropriate solutions leading to self-
reliance and self determination
 Development and utilization of appropriate technology
 focusing on local indigenous resources available in and acceptable to
the community
 Organization of communities arising from their expressed
needs
 Increase opportunities for community participation
 Development of intra-sectoral linkages with other
government and private agencies
 Emphasizing partnership
Framework for meeting the goal of PHC
62

Organizational strategy
callsfor active and continuing
partnership among the communities,
private and government agencies in
health development
 Four cornerstones/Pillars in PHC
63

Active community participation

Intra and Inter-sectoral linkages
Use of appropriate technology
Support mechanisms made available
 Two levels of PHC workers
64

Village or Barangay Health Workers

Intermediate Level Health Workers
 General medical practicioners

 PHN

 RSI

 RHM
LEVELS OF HEALTH CARE
AND REFERRAL SYSTEM
65
 Primary Level of Care
66

Devolved to the cities and municipalities

Health care provided by the center
physicians, PHN, RHM, BHW, TBAs and
others
Usually the first point of contact between
the community members and other levels
of health facility
 Secondary Level of Care
67

Given by physicians with basic health training

Usually given in health facilities either privately owned or
government operated such as
 Infirmaries
 Municipal and district hospitals
 Out-patient departments of provincial hospitals
Serves as a referral center for the primary health facilities
Capable of performing minor surgeries and perform some
simple laboratory examinations
 Tertiary Level of Care
68

Rendered by specialists in health facilities

including medical centers as well as
regional and provincial hospitals and
specialized hospitals
Referral center for the secondary care
facilities
LEVELS OF HEALTH CARE
SERVICES
69
70