Overview of Public

Health Nursing in the

Philippines
By: Mareneth A. Rivera-Borromeo, RN, MAN
 Learning Objectives

1. Integrate relevant principles of social,

physical, natural and health sciences and
humanities in a given health and nursing
situation.
2. Discuss appropriate community health
nursing concepts and actions holistically and
comprehensively.
Global Health
Situation
National Health
Situation
 Public Health

• science and art of (1) preventing disease,

(2) prolonging life, and (3) promoting

health and efficiency through organized

community effort (C.E Winslow)

 Public Health

• connotes organized, legislated and tax-

supported efforts that serve all people

through health departments or related

governmental agencies.
 Public Health

• PURPOSE: Improve the health of the

public by promoting healthy lifestyles,

preventing disease and injury and

protecting the health of communities.

 Community Health
• Global or umbrella term
 Public Health Nursing

• A field of professional practice in nursing

and in public health in which technical
nursing, interpersonal, analytical and
organizational skills are applied to
problems
Standards of Community Health
Nursing
1. Safe and quality 5. Ethicomoral
nursing care responsibility
2. Management of 6. Personal and
resources and professional
environment development
3. Health education 7. Quality
4. Legal Improvement
responsibility 8. Research
Standards of Community Health
Nursing
9. Records
Management

10. Communication

11. Collaboration and

teamwork
 History of Public Health
• 1577- Franciscan Friar Juan Clemente
opened a medical dispensary in
Intramuros for the indigent
• 1690- Dominican Father Juan de Pergero
installed a water system in San Juan del
Monte (San Juan) and Manila.
• Dr. Francisco de Balmis- introduced
smallpox vaccination
 History of Public Health
• 1876- first medicos titulares were
appointed as provincial health officers
• 1888-2-yr course consisting of
fundamental medical and dental subjects
was first offered in UST; graduates of this
course served as male nurses and
sanitation inspectors (cirjuanos
ministrantes)
 History of Public Health
• 1901- US Philippine Commission, through
Act 157 , created Board of Health of the
Philippine Islands, with a Commissioner of
Public Health as its chief executive officer.
- the Board of Health evolved as DOH
now; eventually provincial and municipal
boards of health were formed.
 History of Public Health
• 1912- Fajardo Act created sanitary
divisions; each has a “president” who had
to be a physician, sanitation inspector and
a nurse
• 1915-PGH began to extend public health
nursing services in the homes of patients
by organizing a unit called Social and
Home Care Service, with 2 staff nurses
 History of Public Health
• Puericulture centers were established;
provided maternity and infant care
• 1905- Asociacion Feminista Filipina
founded La Gota de Leche; the first center
dedicated to the service of mothersand
babies
• 1947- DOH was reorganized into bureaus
 History of Public Health
• Quarantine, hospitals that took charge of
the municipal and charity clinics, and
health with sanitary divisions.
• 1954-RA 1082 or Rural Health Act was
passed; creation of Rural Health Unit in
every municipality; provided PHO, public
health dentist in every congressional
district, MHO, PHN, midwives and
sanitation inspectors.
 History of Public Health
• 1957-RA 1891 was enacted; amended
certain provisions in the Rural Health Act
• 1970- Philippine health care delivery
system was restructured; paving the way
for the health care system that exists to
this day where health services are
classified into primary, secondary and
tertiary
 History of Public Health
• 1991- RA 7160 or the Local Government
Code was enacted; devolution of basic
services, including health services to LGU
and the establishment of a local health
board in every province and city or
municipality
 History of Public Health
• September 2000-Philippines signed to the
UN Millenium Declaration during the World
Summit; committed themselves to the
attainment of the 8 MDGs.
• 1999- launched Health Sector Reform
Agenda
• 2005- FOURmula One (F1)
• 2010-Universal Health Care
 History of Public Health

• Universal Health Care aims to achieve the

health system goals of better health
outcomes, sustained health financing, and
responsive health system that will provide
equitable access to health care.
 Roles and Responsibilities of a
Public Health Nurse
• Management function
• Supervisory function
• Nursing care function
• Collaborating and coordinating function
• Health promotion and education function
• Training function
• Research function
The Health Care
Delivery System
World Health
Organization
Millennium Development Goals
1. to eradicate extreme poverty and hunger;
2. to achieve universal primary education;
3. to promote gender equality and empower
women;
4. to reduce child mortality;
5. to improve maternal health;
Millennium Development Goals
6. to combat HIV/AIDS, malaria, and other
diseases;
7. to ensure environmental sustainability;
and
8. to develop a global partnership for
development.
Sustainable Development Goals
1. No Poverty
2. Zero Hunger
3. Good Health and Well-Being
4. Quality education
5. Gender equality
6. Clean water and sanitation
7.Affordable and clean energy
Sustainable Development Goals
8. Decent work and economic growth
9. Industry, Innovation and infrastructure
10.Reduced Inequality
11. Sustainable cities and communities
12. Responsible consumption and
production
13. Climate action
14. Life below water
Sustainable Development Goals
15. Life on Land
16. Peace and justice strong institutions
17. Partnerships to achieve the goal
Department of
Health
 Profile
• The Department of Health (DOH) is the
principal health agency in the Philippines.
It is responsible for ensuring access to
basic public health services to all Filipinos
through the provision of quality health care
and regulation of providers of health goods
and services.
 Mission

• To lead the country in the development of

a productive, resilient, equitable and
people-centered health system
 Vision

• Filipinos are among the healthiest people

in Southeast Asia by 2022, and Asia by

2040
 Local Health System and
Devolution of Health Services
• 1991- passage of the Local Government
Code (RA 7160); all structures, personnel
and budgetary allocations from the
provincial health level down to the brgy.
were devolved to the LGU to facilitate
health service delivery
 Local Health System and
Devolution of Health Services
Objectives:

1. Establish local health systems for

effective and efficient delivery of health
care services.

2.Upgrade the health care management and

service capabilities of local health facilities.
 Local Health System and
Devolution of Health Services
3. Promote inter-LGU linkages and cost
sharing schemes including local health care
financing systems for better utilization of
local health resources.
4. Foster participation of the private sector,
NGO and communities in local health
systems development.
 Local Health System and
Devolution of Health Services
5. Ensure the quality of health service

delivery at the local level.

 Inter Local Health System
• is being espoused by the DOH in order to
ensure quality of health care service at the
local level;
• It is a 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
 New DOH Hospital
Classifications 2015
General Hospital
• A hospital that provides services for all
kinds of illnesses, diseases, injuries or
deformities
• It provides medical and surgical care to
the sick and injured, maternity, newborn
and child care
 New DOH Hospital
Classifications 2015
• It shall be equipped with the service
capabilities needed to support board
certified/ eligible medical specialists and
other licensed physicians rendering
services in, but not limited to the following:
• Clinical Services (Family Medicine,
Pediatrics, Internal Medicine, Obstetrics
and Gynecology, Surgery)
 New DOH Hospital
Classifications 2015
• Emergency Services

• Outpatient Services

• Ancillary and Support Services (Clinical

Laboratory, Imaging Facility, Pharmacy)

 New DOH Hospital
Classifications 2015
Specialty
• Specializes in a particular disease or
condition or in one type of patient
• A specialized hospital may be devoted to
the treatment of the following:
• Treatment of a particular type of illness or
for a particular condition requiring a range
of treatment
 New DOH Hospital
Classifications 2015
• Treatment of patients suffering from a
particular diseases of a particular organ or
group of organs

• Treatment of patients belonging to a group

such as children, women, elderly or others
 New DOH Hospital
Classifications 2015
According to functional capacity
Level 1 General Hospital
• A level 1 General Hospital shall have as
minimum:
• 1. A staff of qualified, medical, allied
medical and administrative personnel
headed by a physician duly licensed by
the PRC
 New DOH Hospital
Classifications 2015
2. Bed space for its authorized bed capacity,

in accordance with DOH Guidelines in the

Planning and Design of Hospitals

 New DOH Hospital
Classifications 2015
3. An operating room with standard
equipment and provisions for sterilization of
equipment and supplies in accordance with:

• DOH Reference Plan in the Planning and

Design of an Operating Room or Theater
 New DOH Hospital
Classifications 2015
• DOH Guidelines on Cleaning, Disinfection,

and Sterilization of Reusable Medical

Devices in Hospital Facilities in the

Philippines
 New DOH Hospital
Classifications 2015
4. A post-operative Recovery Room
5. Maternity Facilities consisting of Ward(s),
Room(s), a Delivery Room, exclusively for
maternity patients and newborns
6. Isolation facilities with proper procedures
for the care and control of infection and
communicable diseases as well as for the
prevention of cross infection
 New DOH Hospital
Classifications 2015
7. A separate dental section/ clinic
8. Provision for blood donation
9. A DOH-licensed secondary clinical
laboratory with the services of a consulting
pathologist
10. A DOH licensed Level 1 imaging facility
with the services of a consulting radiologist
11. A DOH licensed pharmacy
 New DOH Hospital
Classifications 2015
Level 2 General Hospital
• As minimum, all of Level 1 capacity,
including but not limited to:
1. An organized staff of qualified and
competent personnel with Chief of
Hospital/Medical Director and appropriate
board certified Clinical Department Heads
 New DOH Hospital
Classifications 2015
2. Departmentalized and equipped with the
service capabilities needed to support board
certified/ eligible medical specialties and
other licensed physicians rendering services
in the specialties of Medicine, Pediatrics,
Obstetrics and Gynecology, Surgery, their
subspecialties, and other ancillary services
 New DOH Hospital
Classifications 2015
3. Provision for general ICU for critically ill
patients
4. Provision for NICU
5. Provision for HRPU
6. Provision for Respiratory Therapy
Services
 New DOH Hospital
Classifications 2015
7. A DOH licensed tertiary clinical laboratory

8. A DOH licensed level 2 imaging facility

with mobile X-ray inside the institution and
with capability for contrast examinations
 New DOH Hospital
Classifications 2015
Level 3 General Hospital
As minimum, all of Level 2, including but not
limited to:
• Teaching and/or Training Hospital with
accredited residency training program for
physicians in the four major specialties
namely: Medicine, Pediatrics, Obstetrics
and Gynecology, and Surgery
 New DOH Hospital
Classifications 2015
• Provision for physical medicine and
rehabilitation unit
• Provision for ambulatory surgical clinic
• Provision for dialysis facility
• Provision for blood bank
• A DOH licensed level 3 imaging facility
with interventional radiology
 New DOH Hospital
Classifications 2015
Trauma Hospitals
• The trauma capability of hospitals shall be
assessed in accordance with the
guidelines formulated by the Philippine
College of Surgeons
• Trauma Capable Facility is a DOH
licensed hospital designated as a Trauma
Center
 New DOH Hospital
Classifications 2015
• Trauma Receiving Facility is a DOH
licensed hospital within the trauma service
area which receives trauma patients for
transport to the point of care or a trauma
center
Philippine Health Agenda 2016-
2022
• ALL FOR HEALTH TOWARDS HEALTH
FOR ALL
Goals:

1. Financial Protection

2.Better Health Outcomes

3.Responsiveness
Philippine Health Agenda 2016-
2022
• Values

1.Equitable and exclusive

2.Uses resources efficiently
3.Transparent and accountable
4.Provides high quality services
 Lahat Para sa Kalusugan! Tungo sa
Kalusugan Para sa Lahat
• Goals:

1. Investing in People
2.Protection Against Instability
 Lahat Para sa Kalusugan! Tungo
sa Kalusugan Para sa Lahat
Components:

• Universal Health Coverage

• Strengthening Implementation of RPRH
Law
• War against drugs
• Additional funds from PAGCOR
 Lahat Para sa Kalusugan! Tungo
sa Kalusugan Para sa Lahat
• 3 Guarantees:

1. All life stages and triple burden of disease

2. Service Delivery network
3. Universal Health Insurance
 Lahat Para sa Kalusugan! Tungo
sa Kalusugan Para sa Lahat
• Strategy:
Advance health promotion, primary care &
quality
Cover all Filipinos against financial health
risk
Harness the power of strategic HRH
Invest in eHealth and data for decision-
making
 Lahat Para sa Kalusugan! Tungo
sa Kalusugan Para sa Lahat
Enforce standards, accountability and
transparency

Value clients and patients

Elicit multi-stakeholder support for health

 Primary Health Care

• September 6-12, 1978- International

Conference for Primary Health Care was
held At Alma Ata, USSR; 200 countries
attended; Alma Alta Declaration on
Primary Health Care emerged
 Alma Alta Declarations
• Health is a basic fundamental right.
• There exists global burden of health
inequalities among populations.
• Economic and social development is of
basic importance for the full attainment of
health for all.
• Govt’s have a responsibility for the health
of their people.
 Primary Health Care

• 1979- LOI 949 was released, adopting the

PHC strategy making the Philippines the
1st Asian country to embark on meeting the
challenge of PHC.
 What is Primary Health Care?
• Essential health care based on practical,
scientifically sound and socially acceptable
methods & technology made universally
accessible to individuals and families in
the community through their full
participation and at a cost that the
community & country can afford to
maintain at every stage of their dev’t in the
spirit of self-reliance & self determination
 Universal Goal of PHC
HEALTH FOR ALL BY THE YEAR 2000

 acceptable level of health for all the

people of the world through community
and individual self-reliance.
 3 Main Objectives

1. Promotion of healthy lifestyles

2. Prevention of diseases

3. Therapy for existing conditions

5 Key Elements to achieving the
goal “Health for All”
1. Reducing exclusion and social disparities
in health (universal coverage)
2. Organizing health services around
people’s needs and expectations (health
service reforms)
3. Integrating health into all sectors (public
policy reforms)
5 Key Elements to achieving the
goal “Health for All”
4. Pursuing collaborative models of policy
dialogue (leadership reforms)

5. Increasing stakeholder participation.

 Alma Alta Declaration’s 8
essential health services
• Education for health
• Locally endemic disease control
• Expanded program for immunization
• Maternal and child health including
responsible parenthood
• Essential drugs
• Nutrition
 Alma Alta Declaration’s 8
essential health services
• Treatment of communicable and non

communicable diseases

• Safe water and sanitation

 Key Principles of PHC
• Accessibility, affordability, acceptability and
availability
• Support mechanism
• Multisectoral approach
• Community participation
• Equitable distribution of health resources
• Appropriate technology
 Levels of Prevention
• Primary Prevention
 aims to prevent disease or injury before
it occurs.
Ex: legislation and enforcement to ban or
control the use of hazardous products;
education about healthy and safe habits;
immunization
 Levels of Prevention
• Secondary Prevention
 aims to reduce the impact of a disease or
injury that has already occurred; done by
detecting and treating disease or injury as
soon as possible to halt or slow its
progress
Ex: screening tests to detect disease in its
earliest stages
 Levels of Prevention
• Tertiary Prevention
 aims to soften the impact of an ongoing
illness or injury that has lasting effects

Ex: cardiac or stroke rehabilitation programs

 Universal Health Care
(Kalusugang Pangkalahatan)
• Provision to every Filipino of the highest
possible quality of health care that is
accessible, efficient, equitably distributed,
adequately funded, fairly financed and
appropriately used by an informed and
empowered public ( Aquino Administration)
 UHC’s Three Thrusts

1) Financial Risk Protection

2) Improved Access to Quality Hospitals and

Health Care Facilities

3) Attainment of health-related MDGs

Thank you!!!!