Community Health Nursing

People Behind CHN:

MAGLAYA: utilization of nursing process
FREEMAN: he identify 4 level of client health
: individual - least important but most important in hospital
: family - basic unit of care/service/society
: community - most important/primary client
: population group/aggregate - same milestone/character
JACOBSON: achievement of OLOF through health teaching
DR. CE WINSLOW: Birth right of health and longevity
HANLON: proponent of total development
- achievement of highest level of physical, mental and social being.
PURDON: survival of human species
NISCE: raise the level of citizenry

C ommunity (Blackwell)
- group of people living in the same area with the same government.

WHO - foundation of all health practices and standards

- social structure that exhibits and creates norms and values that establishes social institution
(by means of community integration/imbibing)

4 Aspects of the Community

1. Social Aspect - communication and integration of the people.
2. Political Aspect - governance and political will of the people.
3. Cultural Aspect - norms, values, beliefs of the people.
4. Geographical - physical characteristics of the community.

5 Types of Community
A. Urban: increase the number of population
: industrial type of work
B. Rural : decrease in the number of population
: agricultural type of work
C. Rurban: a combination of rural and urban areas
D. Suburban: periphery around a highly urbanized area
: no existing rural ares

H ealth
- concept in determinants of health (OLOF)
- Article 2: Right of every individual

Factors that affect OLOF = ECOSYSTEM (compositions):

1. Behavioral (Culture, Habits, Ethnic Customs)
2. Political (Safety, People Empowerment)
3. Socio-Economic (Employment, Education, Housing)
4. Hereditary (Defects, Strengths, Risks)
5. Environmental (Air, Food, Water)
6. HEALTH CARE DELIVERY SYSTEM
(Promotive, Preventive, Curative, Rehabilitative)

N
- any activities performed by a nurse in according to the restoration and maintenance of health.
Community Health Nursing
- service rendered by a professional nurse with the community, groups, families and individuals at home,
school. Clinic, workplace, etc. for the:
Promotion of Health
Prevention of Disease
Taking Care of a Sick and Rehabilitation

3 Core Concepts:
1. Philosophy of CHN
- based on worth and dignity of man (Margaret Shetland)
2. Ultimate Goal of CHN
- increase the level of health of the citizenry
* increase level of awareness; well being; totality
3. Primary Goal of CHN
- enhance people’s capabilities

Community Based Nursing

- nurses working outside the hospital; generalists
- synthesis of nursing practice applied to promote and preserve health populations

Primary Response: Health Education

Health Teaching
IEC (information, education, communication)
- health education and health prevention

Objectives of CHN
1. Provide s Quality Service
Education
Research
2. Participate in the Development
Implementation
Evaluation
3. Coordinate Nursing Services with the Health Care Team

Principles of CHN
1. Made for ALL
2. Existing Active Groups (women are the most active people in the community)
3. Existing Indigenous Resources (eg. Herbal Plants)
4. Implementations of Health Programs and Services
5. MOST IMPORTANT PRINCIPLE: Health Education

Signs of a Healthy Community

1. Prompt its members “we are community” “participation”
2. Utilize and conserve natural resources
3. Problem-solving, Open Communication
4. Make each of its system available to all
5. Promotes high level of wellness among its members

Levels of Clientele:
1. Individual - “point of entry” - courtesy call to Barangay: Chairman
Municipal: Mayor
Provincial: Governor
2. Family - focal point in nursing care; focus of care --center in delivery of care
3. Group - point of specific care
 Young - injury and accident
 Filipino - cardiac disease
 #1 Cancer - lung cancer
 Filipino -- cancer among men: prostate cancer
women: breast cancer
 #2 leading cause of death in cancer: colorectal
Places in CHN
A. Public Health Nursing
- nurses in the local/national health departments
- starts with salary grade 15; 31k
- science and art of preventing disease

 Ruth Freeman - doctor in public health

 CE Winslow: father of PHN
 3P’s:
 Promote Health
 Prevent Disease
 Prolonging Life

“Life Expectancy” / Swaroops Index

Highest in the World: Monaco
Asia: Japan
Southeast Asia: Singapore

Public Health Objectives

C - Control of Communicable Diseases
O - Organization of Medical and Nursing Services
D - Development of Social Machines
E - Education on Personal Hygiene
S - Sanitation of the Environment

Qualifications of Public Nurse

 Graduate of Bachelor of Science in Nursing
 Registered Nurse
 Good physical and mental health
 Interest and willingness to work in the community
 Capacity and ability to relate, accept, analyze, mobilize and apply nursing process in work
 With leadership potential
 Resourcefulness and creativity
 Active membership to professional nursing organization

WHO - special field in Nursing in combination of the following:

1. Skills in Nursing
2. Some places of Social Assistance
3. Function of all Public Health Programs

Function of the PHN in the City Health Office

 PHN II - frontline health worker; vital signs
- Role of CHN: care provider
 PHN III - Nurse in Charge
- City Health Office Nurses = 2 with 3yrs experience
- Nurse: manage health center; frontline health worker
 PHN V - Nurse Supervisor = RHU (needs master degree + years of experience)
 PHN VI - Nurse Program Supervisor (Head of Nurses)

Head : Mayor
: Municipal Health Officer
: Nurse (Nurse Program Supervisor)
- in line with sanitary inspector and chief medtech
: Midwife
: BHW

Head : Governor
: Provincial Health Officer
: Midwife
: BHW
Law in Public Health Nursing
RA 7305 - Magna Carta for Public Health Workers
RA 7160 - Local Government Code “Revolution Code”
RA 6713 - Code of Ethics and Ethical Standards
RA 1082 - Rural Health Act
- 1st 81 RHU in the Philippines

B. School Health Nursing

Primary Role: ensure that educational potential is not hampered by unmet health needs.

Functions:
 School Health and Nutrition Survey
 Putting up a functional school clinic
 Health Assessment
 Standard Vision Testing For School Children
 Ear examination
 Height and Weight Measurement and Nutritional Status Determination
 Medical Referrals
 Attendance to Emergency Cases
 Student Health Counseling
 Health and Nutrition Education Activities
 Organization of School-Community Health and Nutrition Councils
 Communicable Disease Control
 Establishment of Data Bank on School Health and Nutrition Activities
 School Plant Inspection for Healthy Environment
 Rapid Classroom Inspection
 Home visitation
 Legal Basis of School Health Program:
Article V Sec. 29 - Dangerous Drug Act
PD No. 491 - Nutrition Act of the Philippines
RA No. 856 - Code Sanitation of the Philippines
RA 124 - Every school should have a school clinic
3 Determinants:
1. Characteristics of the client
2. Programs of DOH
3. Policy of the DepEd

2021 Health Events: Healthy Pilipinas

January: World Leprosy Month (Last Week)
February 7: Oral Health Month; Heart Disease Awareness Month
March 8: National Women’s Day
April: World Immunization Week (Last Week)
May: AIDS Candlelight Memorial Day (3rd Sunday)
June: Dengue Awareness Month
July: Nutrition Month
August: National Tuberculosis Awareness Month
September: Rabies Awareness Month
October: Breast Cancer Awareness Month
November: World Tuberculosis Awareness
December 1: HIV Awareness Month

Occupational Health Nursing

Mission of OHN: Ensure that every working person are safe and healthy
PD 856 , Chapter VII - Industrial Hygiene of the Sanitation Code of the Philippines

Primary Role of an Occupational Nurse:

Observe Personal Protective Equipment
Health Hazards Control Measure
Never Neglect
Activities in CHN
1. Clinic Visit
A. Two programs
a) Program Based - the nurse manages the care
b) Non Program Based - medical intervention is needed
B. Standard Procedure
i. Registration - establish rapport, retrieve records
ii. Wating Time - “first come, first served”
iii. Triaging
iv. Laboratory
v. Referral Note
vi. Prescription/Dispensing - give proper instructions
vii. Heath Education - one on one counseling; appointments next visit

2. Home Visit - family-nurse contact

Purpose:
1. Give nursing care to the sick
2. Assess living condition and health practices
3. Give health teachings regarding prevention and control of diseases
4. Establish close relationship between health agencies for promotion of health
5. To make use of inter-referral system
6. Promote the utilization of community services
A. Principles in Home Visit
Involve the family/individual
Prioritize essential Needs (may sakit - last ang communicable; disease - first is most fatal)
Plan should be flexible
Use of Available Information
There should be purpose and objectives
B. Factors Affecting Frequency in Home Visit
Delivered Previous Health Services
Acceptance of the family
Manpower (RN)
Policy of a given agency (school)
Other agency involved
The needs are recognized
C. Resources in Conducting Home Visit
1st thing to do: Handwashing (soap, towel etc)
2nd apron

Public Health Bag

- essential and indispensable equipment in reducing care in the community

Bag Technique
- tool; nurse carry along during home visits

Principles of Bag Technique

1. Prevent the spread of disease / infection
2. To save time and effort
3. Show effectiveness of total care
4. Can be performed in variety of ways

D. Steps in conducting Home Visits

1. Greet the patient and introduce yourself
2. State the purpose of the visit
3. Observe the patient and determine health needs
4. Put the bag in a convenient place then proceed to perform a bag technique
5. Perform the nursing care needed and give health teachings
6. Record all important data, observation and care rendered
7. Make and appointment for a return visit
Epidemiology
- study of occurrence and distribution of disease
- backbone prevention of the disease

Uses (according to Morris)

 Study of history
 Diagnose health of the community
 Study the work of health services with a view of improving them
 Estimate the risk of disease, accident, defects, and the chances of avoiding them
 Identify syndromes by describing the distribution and association of clinical phenomena on the
population
 Complete clinical picture of chronic disease and describe their natural history
 Search for causes of health and disease by comparing the experience of groups

Epidemiologic Triangle
3 Components:
Host - organism that harbors and provides nourishment for another program
Environment - sum total of all external condition
Agent - intrinsic property of microorganisms to survive and multiply in the environment to produce disease

First area: describes the distribution of health status

Second area: explanations of the patterns of disease

Phases of Epidemiological Approach

Descriptive: frequency and distribution of the disease
Analytical - causes and determinant of a disease
Experimental - new approach in dealing with disease
Evaluative - effectiveness of the program or services

Disease Surveillance and Registration

NESS FHSIS
(National Epidemic Sentinel Surveillance System) (Field Health Services and Information System)
- hospital; recording and reporting of cases in the Recording (data base) and reporting (process) data
health sector (Department of Health)

Role: monitoring of all infectious disease with Hospital - National Epidemic Surveillance System2
outbreak potential
Objectives:
 Provide Summary of data on health services delivery
 Provide data used for program monitoring and
evaluation purposes
 Provide standardized, facility level database
 To ensure data are useful and accurate
 To minimize recording and reporting burden of service
delivery level

4 Components:
1. Family Treatment Record
- fundamental block of FHSIS
2. Target Client List
- 2nd building block; sorted per DOH programs
3. Reporting Form/Tally Report
- data routinely transmitted from one facility to another
- prepared and submitted either monthly or quarterly
4. Output Reports
- make reports useful for monitoring or management
purpose

M = Monthly A = Annually
Q = Quarterly M1 = Infectious Diseases (weekly)
Other Laws:
Ra 3573 - Reporting of Communicable Disease
PD 651 - Birth and Death Registration Law of the Philippines (within 30 days)
RA 11332 - Mandatory Reporting of Notifiable Disease and Health events for public health concern act of
2020

Patterns of Occurrence and Distribution

1. Sporadic - on and off / intermittent in case occurrence; few and scattered
2. Endemic - continuous occurrence; cases are constant in a period of time
3. Epidemic - sudden increase in occurrence (AKA: outbreak)
4. Pandemic - simultaneous epidemic of same disease in several countries (worldwide outbreak)

Ottawa Charter
- document; 1986 Canada, Ottawa
- provide guidelines for Health Promotion

5 Action Areas/ Strategies:

1. Building Public Health Policy (eg. Train Law, Sintax)
2. Creating Supportive Environment
3. Strengthening Community Action
4. Developing Personal Skills
5. Reorienting Health Service

 Hospital - center for wellness

 Holistic - entire
 Atomistic - existing
 General Systems Theory - framework/guide

Vital Statistics
- indicate state of Mental Health
- study of vital events and indices of health status of the community

Birth
Death PSA - Philippines Statistics Authority
Marriage Old name: NSO (National Statistics Office)
Annul Diseases: FHSIS
Divorce

Two Vital Events:

Morbidity (Disease) - indicate the health condition of the people whether it is
Mortality (Death) successful or failure in health work.

Uses of Vital Statistics

 Indices of the health and illness status of a community
 Serves as a basis for planning, implementing, monitoring, and evaluating CHN programs and services

Sources of Data:
 Population Census
 Registration of Vital Data
 Health Survey
 Studies and Researchers

PD 651: Requirement Civil Register

Birth = within 30 days (Birth Attendant)
Death = within 48 hours
Morbidity
1. Rate - relationship between vital event
- persons exposed to said event within a given area during a specified unit of time
2. Ratio - relationship between 2 numerical quantities
- measure events without taking particular considerations to time and place
3. Attack Rate - accurate measure at risk for exposure
4. Case Fatality Ratio - killing power of the disease

Demography - study of population

Sources of Data:
 Population Census - counting of population (PSA) (every 5 years)
2 methods:
De JuRE - residence (san ka nakatira) (permanent address)
De Facto - actual phase during survey
 Health Survey
 Family Record (Specific Disease or Condition)
 Studies and Research

TITLE SIGNIFICANCE FORMULA

Crude Birth Rate Sudden increase of population

Crude Death Rate Sudden decrease of population

Maternal Mortality Rate Prenatal Care // OB Care

Index Health Stat of the

Infant Mortality Rate
Community

Fetal Death Rate Pregnancy wastage

Neonatal Mortality Rate Post Partum Care

Sex Ratio Balance of male over male

“longetivity” of life; lifestyle; age-

Swaroop’s Index
proportionate mortality rate

Case Fatality Rate Killing power of a disease

Proportional Mortality
Rate

Dependency Ratio Economic productive

 Incidence Rate Prevalence Rate
Acute Disease in Community Chronic Disease
< 6 months > 6 months
New case only New and old cases
Formula:

Sources of Data:
 Population census
 Registration of Vital Data
 Health Survey
 Studies and Researches

Rates and Ratios:

 Rate: show the relationship between a vital event and those persons exposed to the occurrence of said
event
 Ratio: used to describe the relationship between two numerical quantities or measure of events without
taking particular considerations to time or place.
 Crude or General Rates: referred to the total living population
 Specific Rate: relationship is for a specific population class or group

Priority Health Programs Scope:

1) Sentrong Sigla Movement
2) Herbal Medicine
3) National Voluntary Blood Services Program
4) Botika ng Barangay
5) Expanded Program on Immunization
6) Health Emergency Preparedness and Response Program

Priority Health Programs

1) Sentrong Sigla (SS) Certification
Goal: Quality Health Care, Services and Facilities
Objective: Better and more effective collaboration between DOH and LGU

Scope and Structure of the SS Quality Standards (Level I)

Primary Function: Provide Basic Public Health Services
 Facility System Standards
 Ensure health facility appropriately equipped with sufficient manpower
 Integrated Public Health Function Standards
 Ensure that the health facility promote public health programs
 Prevent problems in care
 Basic Curative Function Standards
 Provide basic curative services in primary level outpatient
 Regulatory Function Standards
 Ensure environment to prevent risks and hazards

Scope and Structure of SS Quality Standards (Level II)

1. Local Health Development
Goal: To strengthen local health system development

Integrated Public Health Functions cover 5 core public health programs:

 Integrated Women’s Health
 Child Care
 Prevention and Control of Infectious Disease
 Integrated Prevention and Control of Lifestyle
 Environmental Health
2) Herbal Plants (LUBBY SANTAT)
: advocated by DOH because of increase cost of drugs.
: Legal Basis - RA8423 (Traditional and Alternative Meds Act)
HERBAL PLANTS OTHER NAME USES
LAGUNDI Vertex Negundo Asthma; Cough; Fever; DOB
Peperomia Pellucida Lowers uric acid in Big Toe
ULASIMANG BATO
Pansit Pansitan Arthritis; Gout
Cleansing of wounds (anti septic)
Guava Toothaches; mouth infections;
BAYABAS
Psidium Guajava swollen gums
Lowers BP and Cholesterol
Lower cholesterol level
BAWANG Allium Sativum Anti Prostaglandin
Hypertension; Toothache
Peppermint For pains of the body;
YERBA BUENA
Mentha Cordifolia Opiz Ex Fresen dysmenorrhea and gas pain
Swelling (anti edema); diuretics;
SAMBONG Blumea Balsamifera Anti Urolithiasis/Bato/Kidney
Stone
Infected skin; Athlete’s foot
AKAPULKO Cassia Alata
Skin irritation; Anti-fungal
NIYUG NIYOGAN Quisqualis Indica Ascaris; Anti-Helminthic; Parasite
Carmona Retusa
TSAANG GUBAT For stomachache; diarrhea
Ehretia Microphylla Lam
Decrease blood sugar;
AMPALAYA Mamordica Charantia DM Type II (mild insulin
dependent)
TAWA TAWA - Increase platelet count

3) National Voluntary Blood Services Program

: RA 7719 - Blood Services Act of 1994

Objectives:
 To promote and encourage voluntary blood donation by the citizenry and to instill public consciousness
of the principles the blood donations is a humanitarian act.
 To provide adequate, safe, affordable and equitable distribution of supply of blood and blood products
 To mobilize all sectors of the community to participate in mechanisms for voluntary and non-profit
collection of blood

Vision:
Envision a network of modernized national and regional blood centers operating on a fully voluntary,
non-remunated blood donation system

Mission:
Ensure adequate, safe and accessible blood supply:
 Promoting voluntary blood donation
 Establishing new blood service facilities
 Organizing association of blood donors and training medical practitioners on national blood
use.

Requirements before donating:

 Be in good health
 Systolic BP: 90-160mmHg
 Diastolic: 60-100mmHg
 Hemoglobin at least 12.6g/dL
 Be age 16-65 years (for ages 16&17, parental consent needed)
 Weigh more than 45kg (100lbs) for 250mL of donated blood
50kg (110lbs) for 450ml of donated blood
Contraindications:
 Diabetes
 Cancer
 Hyperthyroidism
 Cardiovascular Disease
 Severe Psychiatric Disorder
 Epilepsy/Convulsion
 Severe Bronchitis
 Malaria
 Kidney and Liver Disease
 Prolonged Bleeding
 Use of Prohibited Drugs
 AIDS/Syphilis and other STI (past and present)

Blood Extracted for Donations

 Whole blood and red cell concentrates
 Shelf-life to 5 weeks
 Plasma
 Can be stored frozen for 12months
 Considerations after Blood Donation:
 Bruising or discoloration may occur and will disappear
 Avoid carrying heavy objects with your donating arm
 Do not smoke for the next 2 hours
 Avoid alcohol intake for the next 12hrs
 Eat regular meals and increase fluid intake following your donation
 Leave the adhesive dressing on your arm for for at least 3hrs but not more than 12hrs.

4) Botika ng Barangay
Goal: To promote equity in health by ensuring the availability and accessibility of affordable, safe and
effective quality essential drugs to all, with priority to marginalized, underserved, critical and hard to reach
areas.
Objectives:
 To rationalize the distribution of common drugs and medicine among intended beneficiaries
 To serve as mechanism for the DOH to establish partnership with LGU
 Optimize involvement of BHW addressing the health need of the community
Essential Drug Use (Should be in Botika ng Barangay)

C Contrimoxazole
Antibiotics
A Amoxicillin
R Rifampicin
I Isoniazid Anti TB drugs
P Pyrazinamide
P Paracetamol Anti Pyretic Analgesic
O ORS/Oresol Dehydration
N Nifedipine Calcium Channel Blockers
Anti Hypersensitive

5) Expanded Program on Immunization

Principles:
 It is safe and immunologically effective to administer EPI vaccines on the same day at different sites of
the body
 Measles Vaccine in endemic area = 6mons
 85% protection = 9 months
 95% protection = if given 1 year and older
 Less dosage - less antibody response
 No extra must be given to children/mother who missed a dose of DPT / HEPA B / OPV / TT

PD 996: EPI (old law) - free vaccine for ages 8 and below
RA 10152: Mandatory Basic Immunization for Infants and Children
(+) Pentavalent = 5 in 1: DPT
HEpa B
HI-b (Haemophilus Influenza Type B)
(+) Rotavirus (2 dose)
- Rota Infection (Diarrhea)
(+) IPV - Inactivated Polio via IM
MMR - Measles, Mumps, Rubella

5 Elements of EPI
S - Surveillance (search for case as a form of evaluation)
I - IEC (Information, Education, Communication)
C - Cold Chain & Logistics Management (all vaccines are sensitive to heat)
A- Assessment and Evaluation
T - Target Setting - Primary Element: Eligible Population

National Immunization Day

Wednesday - Health Center
Monthly - Barangay Health Station (-) Refridge
Quarterly - for far flung areas
Far flung Areas - GIDA (Geographically Isolated and Disadvantage Area

OPV, Antimeasles
Most Sensitive Freezer -15 to -25 MCV-I, MMR
Measles Containing Vaccine
BCG, Pentavalent
Less Sensitive Body +2 to +8
Hepa B, TT
Never store in the refridgirator door
Check 2x a day upon entering and leaving the shift
Infant EP: total x 2.7%
Pregnancy EP: total x 3.5%

VACCINE DOSE SCHEDULE ROUTE DOSAGE SITE

1 Birth ID 0.05 cc R Deltoid
BCG Booste
Upon School Entrance ID 0.05 cc L Deltoid
r
Vastus L
Birth (upper outer
HEPA B 1 IM 0.5 mL
2nd: 6 weeks, 3rd: 8 weeks portion of the
thigh)
PENTAVALENT 3 1/2, 2 1/2, 3 1/2 months IM 0.5 mL Vastus L
OPV
3 1/2, 2 1/2, 3 1/2 months ORAL 2gtts Mouth
(live attenuated)
IPV
1 3 1/2 months IM 0.5 mL Vastus L
Inactivated (killed)
ROTA VACCINE 2 1 1/2, 2 1/2 months ORAL 1.5mL Mouth
MMR 9 months (long term)
2 SQ 0.5 mL Arms / Thigh
(cause mild rash) 12 months (booster)
PNEUMONOCOCCAL CONJUGATE VACCINE (3 DOSES)

6) Health Emergency Preparedness Preparedness and Response Program

Goal:
 Promoting Health Emergency Preparedness among the general public
 Strengthening the health sector capability and response to emergency disaster
 Legal Mandate:
 Presidential Decree No 1566 (1978) - Strengthening the Philippine Disaster Control Capability and
Establishing the National Program on Community Disaster Preparedness
 Republic Act No 7160 (Local Government Code of 1991)
 Transfer Responsibilities from the national to local government unit
Disaster and Health Emergency Management
Disaster - disruption of the functioning of a society

Classification of Disaster according to it’s cause

1. Natural Disaster
2. Human Generated / Man - made

Emergency
 Requires an immediate response
 It is the responsibility of all
 It should be woven into the community and administrative levels
 It should concentrate on process and people rather than documents
 Main Objective: decrease mortality, morbidity and prevent disability

Hazards
- Any phenomenon, which has the potential to cause disruption or damage to humans and their
environment

General Principles:
 First Priority: protection of the people who are at risk
 Second Priority - protection of critical resources and systems on w/c communities depend
 Disaster management must be an integral function of national development plans and objectives
 Disaster management relies upon an understanding of hazard risk
 Capabilities must be developed prior to the impact of hazard risks
 Disaster management must be based upon interdisciplinary collaboration

Major Tasks to be Considered:

1. Natural Risks
- Flood, earthquake, cyclones
2. Technical Risks
- chemical, radiological, other events caused by the failure of socio-technical systems
3. Epidemics
4. Societal Risks
- caused by social exclusion, extreme poverty and group evidence

Philippine Health Care Delivery System

PUBLIC SECTOR DEPARTMENT OF HEALTH
 Serve as national policy and regulatory institution
 Provide leadership in formulation, monitoring & evaluation
LEADERSHIP IN HEALTH of policies, plans and programs
 Serves as advocate in the adoption of health policies, plans
and programs
 Innovate new strategies in health
 Exercise oversight functions, monitoring and evaluations of
ENABLER AND CAPACITY national health plans, programs and policies
 Ensure the highest achievable standards of quality health
care, health promotion and health protection
 Manage selected national health facilities and hospitals with
modern and advanced facillities
ADMINISTRATOR OF SPECIFIC
 Administer direct services for emergent health concerns
SERVICE
that require new complicated technology
 Administer health emergency response

PHCDS Vision:
Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040.

PHCDS Mission:
To lead the country in the development of a productive, resilient, equitable and people-centered
heath system.
Ecosystem - influence of OLOF (old)

Advance Health Care Regional; Medical Center, National Hosp, Specialty Hosp

Diagnostics Emergency, District, Provincial

Primary Basic Health Care (simple cases)

- accessible -eg. Wounds

RHU/HEALTH CENTER BARANGAY HEALTH STATION

- main center - satellite station
- complete Health Care Team - manned by public health midwife
- w/in 3-5km radius w/in 30mins

PHM 1 : 5,000 / barangay

PHN
Medtech
1 : 10, 000
Sanitary Inspect
Physician
Dentist 1 : 50, 000

3C’s Nurse Supervisor

Communication Physician Manager
Cost Effective Midwife Frontline
Care Efficiency BHW Initial contact

Department of Health
- primary agency of country for health
National authority to health
Secretary: Francisco Duque

Vision by 2030
L - Leader B - Better Health Outcome
A - Advocate E - Equitable Health care Financing (Philhealth)
M - Model in Promoting Health for all M - More responsible Health System

Mission
Q - Quality Health
E - Excellence, Equitable
S - Sustainable

Principles to Attain the Vision of DOH (EQA)

 Equity - equal health service for all (no discrimination)
 Quality - DOH is after the quality of service not the quality
 Accessibility - DOH utilize strategies for delivery oh health services

EO102 - 3 function DOH

L: Leadership in Health: Policies - “Admin Order”
E: Enables and Capacity Builder; new programs, strategies
A: Administrative Function - Manage Tertiary and Specialty Services
RA 7160: Local Government Code (LGU)
Devolution DOH: Formulate
Transfer of Power
Decentralization LGU: Implement

2 Aspect:
PROVINCIAL GOVERNMENT MUNICIPAL CITY GOVERNANCE
CHAIRMAN / LOCAL CHIEF EXECUTIVE
Approves: Governor Mayor
VICE CHAIRMAN
Recommend: Provincial Officer MHO/CHO

Manage Secondary Facility Manage Primary Facility

National Objectives for Health

 Goal of DOH
 Road map for all stakeholder of health (guide)

Health Sector Reform Agenda (HSRA)

 Overriding goal of DOH

Gloria Macapagal Arroyo

 FOURmula One for Health
- framework for health sector reform agenda to implement critical interventions
 Key Feature: NHIP (National Health Insurance Program

Benigno Aquino (Aquino Health Agenda)

 Kalusugan Pankalahatan (2010-2016)
- embraces everyone across lifespan
 DOH (RN Heals) (Ang NARS) (NDP) - Salary 18k

Trust Program:
1. Financial Risk Protection (Equitable Health Financing)
- enrolment and membership of PhilHealth
2. Achieving Health - Related MDG
- reduce to have better health outcome
3. Improving acess to quality health facilities
- for responsible health system

Rodrigo Duterte / Philippine Health Agenda

> All for Health towards Health for All (2016-2022)
Goals: Financial Protection, Health Outcomes, Responsiveness
Our values and Objectives:
1. Equitable and Inclusive
2. Efficient and Sustainable
3. High Quality and Comprehensive
4. Transparent and Participatory

Philippine Health Agenda Framework

 3 Guarantee:
1. All life stages and triple burden of disease
a) Communicable Disease
b) Non-Communicable Disease
c) Diseases of Rapid Urbanization and Industrialization
- Injuries, Mental Illness, Substance Abuse
2. Services are delivered by networks that are:
a) Fully Functional
b) Available 24/7
c) Practice Gate keeping (close to people)
d) Enhance Telemedicine
3. Services are financed predominantly by PhilHealth / Universal Health Insurance
RA 10606; June 19, 2013 - PhilHealth Law
- Ghosting
- Viscaling
Case Role Method for Reimbursement = final diagnosis of doctor
Mafia sytem - may kakuntsaba

> 100% of Filipinos are members

PHILHEALTH AS THE GATEWAY TO FREE
> Formal Sector premium paid through payroll
AFFORDABLE CARE
> Non-formal sector premium paid through tax subsidy
> No balance billing for the poor/basic accommodation
SIMPLY PHILHEALTH RULES
and fixed co-payment for non-basic accommodation
> Expand benefits to cover comprehensive range of
PHILHEALTH AS MAIN REVENUE SOURCE
sevices
FOR PUBLIC HEALTHCARE PROVIDES
> Contracting networks of provides within SDNs

Categories for Membership

>Membership Data Record
1. Private (Formal)
2. Indigent/NHTS-PR (National Household Targeting System - Proverty Reduction; DSWD; 4 P’s -- NON
CONTRIBUTOR
3. Senior Citizen - no debt at age of 60 / PWD
4. Sponsored (by the employees) NON CONTRIBUTOR
5. Lifetime Member (120 months of contribution)
6. OFW - needs to pay PhilHealth
7. Domestic Worker
> no balance billing and fied co-payment
PHILHEALTH: NHIP // National Health Insurance Program (Old Name: Medicare)

RA11223 - Universal Health Law = All Filipino are automatic enrolled in PhilHealth
- SIN tax reform law

CONTRIBUTORY NON CONTRIBUTORY

Indigents (poorest of the poor), sponsored
Self employment, employed
member, PWD, lifetime member (senior citizens

Our Strategy
A Advance quality, health promotion and primary care
C Cover all Filipinos against health-related financial risk
H Harness the power of strategic HRH development
I Invest in e-health and data for decision-making
E Enforce standards, accountability and transparency
V Valve all client and patients, especially the poor and vulnerable
E Elicit multi-sectoral and multi-stakeholder support for health

FOURmula One Plus

Theme: Boosting Universal Health Care
Strategic Goals:
B Better Health Outcomes
E Equitable and Capacity Builder
M More responsive health system

Roles and Functions of DOH

L Leadership in Health
E Enabler and Capacity Builder
A Administrator of Specific Service
5 PILLARS/ELEMENTS
1. Health Financing: investment financing thru PhilHealth
: NHIP (National Health Insurance Program)
2. Health Regulation: Affordable Quality (RAQ)
: eg. generic act, cheaper meds act
3. Health Service Delivery: quality and accessible
4. Good Governance: T - transparent
A - Accountable
E - Efficient
5. Performance Accountability
- improve transparency and accountability
- outcome based management approach

UNITED NATION: “2000”

Millenium Developmental Goals (8 Goals)
Ultimate Goals: Poverty Eradication (Reduction 2015)
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empowerment
4. Reduce child mortality rate by 2/3
5. Reduce maternal mortality rate by 3/4
6. Combat HIV/AIDS, malaria and other disease
7. Ensure environmental sustainability
8. Develop a global partnership for developmental
--- Health Related: 4, 5 , 6 ---

Sustainable Developmental Goals // Global Goals

Target Year: 2030 (17 Years, 169 targets)
Ultimate Goals: 3P’s
Poverty Eradications/Reductions
Protect Planet Earth
Peace and Prosperity
1 No poverty (MDG 1)
2 Zero Hunger (MDG 1)
3 Good Health and Well-being (9 targets) (3.2)
4 Quality Education (MDG 3)
5 Gender Equality (MDG 3)
6 Clean Water and Sanitation
7 Affordable and Clean Energy
8 Decent Work and Economic Growth
9 Industry Innovation and Infrastructure
1 Reduce Inequalities
0
1 Sustainable Cities and Communities
1
1 Responsible Consumption and Production
2
1 Climate Action
3
1 Life below Water
4
1 Life on Land
5
1 Peace, Justice and Strong Institution
6
1 Partnership o achieve the goals
7
6, 7, 12, 13, 14, 15 - All Environment Related Goals

Environmental Health and Sanitation ( Laws and Policies )

PD 856 - Environmental Sanitation Code of the Philippines
PD 825 - Improper garbage disposal law
RA 9003 - Ecological Solid Waste Management Act
RA 9275 - Clean Water Act
Ra 8749 - Clean Air Act
RA 6969 - Toxic Hazardous Nuclear Waste Control

Water Sanitation
3 Unapproved Water Source Facility:
1. Open Dug Wells “Balon”
2. Unimproved Spring
3. Well that needs Priming / Repair ( Poso de bomba )

3 Levels of Approved Water Source Facility

LEVEL DISTANCE DISTRIBUTION OF H20 HOUSEHOLDS
I. Point Source
250 meters 40 - 140 L / min 15 - 25
- without pipe distribution system
II. Communal Faucet
25 meters 40 - 80 L / capital / day 100
- with pipe distribution system
III. Water Works System owns connection

Excreta Disposal
3 Levels:
1. Non Water Carriage
i. Negative - no water
1. Reed Odorless Earth Closet
2. Closed Pit Privy
3. Pit Latrine
4. Bucket Latrine ( Arenola )
5. Ventilated Improvised Pit
ii. Minimal
- pour flush (debuhos )
2. Water carriage - water sealed type of toilet
- septic tank (malabanan)
3. Water carriage - water sealed type of toilet
- sewage system (treatment of toilet facility) = organic fertilizer

Family Care Plan

- blueprint of nursing care
Nursing Process - ADPIE (Implicit of CHN)
Assessment:
> First Level
- what are the problems
- list of family nursing problem

Categories of Nursing Problem:

1. Wellness State: Healthy -> Healthier
2. Health Deficit: Disease / Disability
3. Health Threat: Increase Risk for Injury / Illness
4. Foreseeable Crisis / Stress Point: anticipated problem
: Developmental/Social in nature
= you just have to adjust
> Second Level of Assessment
- “why problems”
Diagnosis:
> 5 Family Diagnosis:
1. Inability to recognize presence of condition / problem
2. Inability to make decision
3. Inability to provide a home environment
4. Inability to provide adequate nursing care
5. Failure to utilize community resources

Planning
First Step: Goal Setting
Constructing Plan of Action: Choose Nursing Intervention
Develop Operational Plan: Prioritize

Family Prioritization
4 CRITERIA WEIGHT
1. Nature of the Problem
1
(Category of the Problem)
2. Modifiability of the Problem
2
(Solution to the Problem)
3. Preventive Potential
1
(Future Reoccurence of the Problem)
4. Salience
1
(Perception of the Client about the Problem)
Total: 5

Community Priorization
COMMUNITY WEIGHT
1. Nature of the Problem 1
2. Modifiability of the Problem 4
3. Prevential Problem 1
4. Social Concern 1
5. Magnitude of the Problem 3
Total: 10

Implementation: involve various nursing intervention

: carry out nursing procedure
: document is done

Local Health System

RA 7160 - Local Government Code
> Objective of Local Health System
 Establish local health system
 Upgrade the health care management and service capabilities of local health
 Promote LGU (inter) linkages and cost sharing schemes
 Foster participation of the private sector, non-government organization and community

> Inter Local Health System

 It is a system of health care similar to a district health system
 System that is being espoused by DOH in order to ensure quality of health care service

> Composition of Inter-Local Health Zone

1. People
2. Boundaries
3. Health Facilities
4. Health Workers

DOH Programs
Vision: Filipinos are among the healthiest people in Southeast Asia by 2022, and in Asia by 2024
Mission: to lead the country in the development of a productive, resilient, equitable, and people - centered
health system

Primary Health Care ( September 6 - 12, 1978 )

- PHC approach applied in COPAR
- Resilient, Equitable and ___
> Letter of Instruction 949 (Legal Basis of PHC)
- Signed by President Marcos on October 19. 1979
- 4A’s - Acceptable, Affordable, Available, Accessible to all

Goal (1978): HEALTH FOR ALL by year 2000

Underlying theme (2010): health for all and health in the hands of people by year 2010

PHC // Essential Health Care

E Education for Health Problem
L Locally Endemic Disease Prevention and Control
E Expanded Program Immunization (EPI)
M Maternal and Child Health and Family Planning
E Essential Drug Use and Herbal Medicine
Nutrition and Food Supply
N
(Food Fortification and Sangkap Pinoy Seal)
T Treatment of Communicable and Non-Communicable Disease
Sanitation of Environment and Safe Water Supply
S
(PD 856 - Sanitation Code of the Philippines)
D Dental Health Promotion -> Dental Prophylaxis
A Access to Hospitals as Center of Wellness
M Mental Health Promotion

Mission:
Increase opportunity that will manage their own Health Care
3 Core Concept / Principles:
P - Partnership with people
E - Empower People
= transfer knowledge, skills and attitude
S - Self Reliance
4 Pillars and Cornerstones
A Active Community Participation
I Intra and Intersectoral Linkages
U Use of Appropriate Technology
S Support Systems are made available

Levels of Prevention / Family Nursing Process Nature of Problem

LEVEL PRIMARY SECONDARY TERTIARY
“WHO?” Healthy High Risk Post Treatment
Rehab
Early Diagnosis and Prevent other complications:
Health Promotion and
Activities Screening
Illness Prevention
= Early Treatment Palliative/Supportive/Symptomatic Care
- 6 months to live

Epidemiology - study of occurrence and distribution of disease

John Snow - father of Epidemiology

Reproductive Health
Reproductive Health Law: RA 10354

4 Main Objectives
1. Reduce Maternal Deaths
2. Reduce Child Mortality
3. Increase Access to Information and Services
4. Halting the spread of HIV

4 Priority Elements
1. Family Planning
2. Maternal and Child Health and Nutrition
3. Adolescent Reproductive Health
4. Prevention of HIV and STD

Maternal Health Program

- improve survival, health and well-being among mothers and unborn

Objectives of Prenatal Care

1. Reach out all pregnant women
2. Ensure and safe healthy delivery

1. AGE
Normal: 18 to 35 y/o
At Risk - 17 below and 36 above
2. Height
Normal: 4’10
At Risk - 4’9
3. Gravida
Normal: G1 to G4
At Risk - G5 and above
4. History
5. Present Condition

HBMR
- Home Based Mother Record

Purpose:
1. Identify Risk Factors
2. Recognize danger signs
3. Implement Appropriate Nursing Care

Essential Maternal Health Services:

Encourage and support breastfeeding
1. Benefits of Breastfeeding to Mothers and Infants
- it will prevent unplanned pregnancy
- it will provide post partum bleeding
- it will prevent occurrence of cancer
- it will provide complete nutrition
- it will prevent infection and increase immunity
- it will increase IQ points

2. Micronutrient Supplementation
 Vitamin A (Retinol) - prevent MR, blindness
Pregnant - 10, 000 IU ( 4th - 9th month of pregnancy ) twice a week + Vit A foods
Post Partum - 200, 000 IU ( 1 dose within 4 weeks + Health Educ to eat Vit A )

 Iron Supplement (Folic 400 - 800 mcg / tab)

1st trimester 60 mg elemental iron / day for 6 months
2nd and 3rd trimester 120 mg elemental iron / day for the entire pregnancy
Post partum 60mg elemental iron / day for 3 months

Nutrition Program
RA 8976 - Food Fortification Law
Araw ng Sangkap Pinoy (Food Fortification Program) - added nutrient
Goal: improve quality of life of Filipinos through better nutrition, improved health and increased productivity

Program and Projects:

 Micronutrient Supplementation
  Food Fortification
 Essential Maternal and Child Service Package
 Nutrition Information, Communication and Education
 Home, School and Community Food Production
 Food Assistance
 Livelihood Assistance

Deliver Tetanus Toxoid

Fully Immunized Mother - 5 doses
Prevent Tetanus Neonatorum - 2 doses
TETANUS TOXOID WHEN TO GIVE PROTECTION PERCENTAGE
TT1 asap during pregnancy 0 yrs of protection 0%
TT2 1 month after the dose 3 yrs of protection 80%
TT3 6 months after the second dose 5 yrs of protection 95%
TT4 1 year after the 3rd dose 10 yrs of protection 99%
TT5 one year after the 4th dose lifetime 99%
If Fully immunized, Anti Tetanus Serum / Tetanus Immunoglobulin / Tetanus Anti Toxin

Solutions to Other Problems/Conditions

1. Complication

EmONC BEmONC CemONC

( Emergency Obstetric and Newborn Care ) ( Basic Emergency Obstetric ( Comprehensive Emergency Obstetric
- women’s health safe motherhood and Newborn Care ) and Newborn Care )
- safe pregnancy program of the DOH

Population 1: 125, 000 1: 500, 000

Travel Time within 30 mins within 1hr
Delivery, IV fluids and All BEmONC services + CS
Services
Dilatation and Curettage delivery and blood transfusion

Child Health Care

Newborn Screening - RA 9288
RA 7600 - Rooming in Act
EO 51 - milk code
PD 996 - Expanded Program on Immunization (EPI)

COPAR (Community Organizing Participatory Action Research)

- plan and solve community problem
- to enhance community participant
- to develop self-reliance and people empowerment

Role of People: Leader

Role of Nurse: Facilitator (Assist / Teach)

Community Organizing - process and structure wherein the people become more organized in participation
in health care and development activities
Goal of Community Organizing: Community Development
Goal of Community Development: Better Life

PAR (Participatory Action Research)

- Community directed process of collecting, organizing and analysis (of data) for change.

Objectives:
1. To develop competence for change
2. Encourage consciousness
3. To help in building organization

PHASES
1. PRE ENTRY
2. ENTRY
3. COMMUNITY STUDY/DIAGNOSIS (CDx)
4. COMMUNITY ORGANIZING AND CAPABILITY BUILDING
5. COMMUNITY ACTION
6. SUSTENANCE AND STRENGTHENING

PRE ENTRY (program first)

1. Formulation of programs: Goals and Objectives based on the vision, mission and goals of the institution.
2. Conduct COPAR staff training.
I. Community Organizer - RN
II. Training Coordinator - Trains and Controls Vaccination
III. Health Services Coordinator - Nurse in Health Center
IV. Student Immersion Coordinator
3. Conduct PSI ( Preliminary Social Investigation )
- gathering of information of different barangays for potential to be an adopted community
- poor, depressed, underserved
4. Meet the key leaders ( Accept, Support, Participate )
5. Spot mapping ( vulnerable groups, health status, health resources )

ENTRY
1. AKA: Community INTEGRATION
- courtesy call ( upon entry )
- foster parenting
- participate in direct production activities
2. Conduct DSI ( Deepening Social Investigation )
- values, weakness, interest, strength
3. Provide basic health care services
- Primary Health Care implementation
4. Conduct SALT ( Self Awareness Leadership Training )
- intended for potential leaders
5. Core Group Formation
- group of indigenous people
Rules and Functions:
Prepare for Community Health Development Work
Organize Research Team ( RN - outside ; community - local )
Set up Community Health Organizers
Organize and mobilize during immediate health needs

COMMUNITY STUDY / CDx

1. Training on data collection, organization, and analysis
2. Plan when to conduct actual survey ( plan by local researcher )
3. Actual data gathering
4. Data Organization
5. Data Presentation ( Barangay ) - should be the local researcher
6. Data Prioritization

COMMUNITY ORGANIZING AND CAPABILITY BUILDING

1. Develop management process
2. Election of officers and members
3. Discuss their roles and functions
4. ARAS ( action reflection action session) - meeting and planning

COMMUNITY ACTION
PIME ( Program, Implementation, Monitoring, Evaluation )
Identify other resources
Set-up Linkages and Networks
Organize and Training of Community Health Workers
SUSTENANCE AND STRENGTHENING
1. Develop FINANCIAL management
2. Identify secondary leaders
3. Develop medium and long term health planning
4. Negotiate for absorption of CHN to LGU through BHW
5. Formalize linkages and networks