Module 3 (Part 2) - Lecture Notes

Community and Public Health
for Medical Laboratory Science (MLS

1305)
MODULE 3 (Part 2)
THE PHILIPPINE HEALTH CARE

DELIVERY SYSTEM
Prepared by:
Angelique C. Dumlao, RMT
Summer 2020
Module no. 3 | The Philippine Health Care Delivery System

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MLS 1305 (Community and Public Health for Medical Laboratory Science)
Course Topics:
Module 3.3 - Primary Health Care

 Rationale, Definition and Goal of PHC
 Strategies of PHC
 Elements of PHC
 Traditional Medicines and Indigenous Resources
Learning Objectives:
At the end of the module, the learner must be able to:
 Identify the strategies used in primary health care
 Discuss the Elements of Primary Health Care
 Categorize Primary Health Care Workers according to levels
 Familiarize oneself with DOH's 10 Herbal Medicine
Module 3.2 - The National Health Plan

 Principle of Health Care process
 Concepts of family
 Types of Family
 Roles and Responsibilities of family members
 Health Care Process for a Family
Learning Objectives:
At the end of the module, the learner must be able to:
 Define the health care process
 Describe the roles of each member of the family
 Differentiate families according to their structure
 Apply health care process in family setting
 Formulate health care objectives for a family care

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Module 3.3 - Primary Health Care
Introduction
Review: What is Health?

 health, which is a state of complete physical, mental and social well-being,
and not merely the absence of disease or infirmity, is a fundamental
human right.
 the attainment of the highest possible level of health is a most
important world-wide social goal whose realization requires the action of
many other social and economic sectors in addition to the health sector.
The Alma-Ata Declaration
The Alma-Ata Declaration of 1978 affirms the crucial role of primary health care,
which addresses the main health problems in the community, providing promotive,
preventive, curative and rehabilitative services accordingly. It stresses that access
to primary health care is the key to attaining a level of health that will permit all
individuals to lead a socially and economically productive life and to contributing to the
realization of the highest attainable standard of health.
PHC is usually the first point of contact people have with the health care system.
Primary Health Care (PCH)

- it deals with social policy which targets health equity
- The Alma-Ata Declaration defines it as an important health care derived from
scientifically sound and socially acceptable methods. It must be universally
accessible to all individuals and is based on what the community and country
can provide.

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- According to WHO, PCH addresses the majority of a person’s health needs
throughout their lifetime. This includes physical, mental and social well-being
and it is people-centred rather than disease-centred. PHC is a
whole-of-society approach that includes health promotion, disease prevention,
treatment, rehabilitation and palliative care.
Universal definition:
“essential care based on scientifically sound and socially acceptable methods
and technology made universally accessible to individuals, families, and
communities through their full participation, at a cost they can afford at any given
stage of development, and with the goal of self-reliance and self-determination”
Primary Health Care Paradigm
Made accessible,
attainable, sustainable
and affordable to the
people towards a...
Rationale for the Development of PHC

1. Magnitude of health problems
2. Inadequate and unusual distribution of health resources
3. Increasing cost of medical care
4. Isolation of health care activities from other development
A health system based on primary health care will:

 build on the Alma-Ata principles of equity, universal access, community
participation, and intersectoral approaches;
 take account of broader population health issues, reflecting and reinforcing public
health functions;
 create the conditions for effective provision of services to poor and excluded
groups;
 organize integrated and seamless care, linking prevention, acute care and
chronic care across all components of the health system;
 continuously evaluate and strive to improve performance

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General Principles of Primary Health Care:
1. Health and development are interrelated

Health is not merely the absence of disease. Neither it is only a state of
physical and mental well-being. Health being a social phenomenon recognizes
the interplay of political, socio-cultural and economic factors as its determinant.
Good health therefore, is maniested by the progrssive improvements in the living
conditions and quality of lie enjoyed by the community residents.
Development is a quest or an improved quality of life for all.

Development is multi-dimensional. It has political, economic, social, cultural,
institutional and environmental. Therefore, it is measured by the ability of people
to satisfy their basic needs.
Thus, the interrelationship of health and development.
MAN AS A FACTOR OF PRODUCTION
PRODUCTION HEALTH AND

QUALITY OF LIFE
GOODS AND SERVICES
THE POVERTY AND ILLNESS CURVE
LOW PRODUCTION
INCAPACITY AND SHORTER LIFE

EXPECTANCY LOW WAGES
MORE ILLNESS
LESS ENERGY AND HIGHER
INCAPACITY
LOW IVESTMENT IN SANITATION AND MALNUTRITION, POOR
PREVENTION EDUCATION, HOUSING, ETC.
HIGH EXPENSES IN CURATVE

ACTIVITIES

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2. Essential health services must be accessible, available, acceptable and
affordable
The health services should be present where the supposed recipients are.
They should make use of the available resources that is found in the community,
wherein the focus would be more on promotive of health and prevention of
illness.
3. Genuine people's participation is essential

People are the center, object, and subject of development. Thus, the
success of any undertaking that aims at serving the people is dependent on the
people's participation at all levels of decision-making: planning, implementing,
monitoring, and evaluating. Any undertaking must also be based on the people's
needs and problems (PCF 1990).
Part of the people's participation is the partnership between the

community and the agencies found in the community;social mobilization; and
decentralization.
In general, health work should start from where the people are building on
what they have.
Other Principles of Primary Health Care:
1. Improvement in the level of health care of the community.

2. Favorable population growth structure.
3. Reduction in the prevalence of preventable, communicable and other disease.
4. Reduction in morbidity and mortality rates especially among infants and children.
5. Extension of essential health services with priority given to the undeserved
sectors.
6. Improvement in basic sanitation.
7. Development of the capability of the community aimed at self-reliance.
8. Maximizing the contribution of the other sectors for the social and economic
development of the community.
9. Equitable distribution of health care
according to this principle, primary care and other services to meet the
main health problems in a community must be provided equally to all
individuals irrespective of their gender, age, and caste, urban/rural and social
class.
10. Community participation
The desire to get involved must be generated from within the community.
Its participation entails productive contact between the health service and the
people for specific needs. Health actions must be a response of a community
to problems that the people themselves perceived and carried out in a way
that is acceptable to them.

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11. Multi-sectional approach
Multi-sectional approach-recognition that health cannot be improved by
intervention within just the formal health sector
12. Use of appropriate technology
Ultimate goal of PHC: SELF-RELIANCE

- the ability to stand on their own; self - sufficiency
Major Strategies of Primary Health Care:

Based on Visions, Policies, and Strategies of the DOH, Philippines
1. Elevating Health to a Comprehensive and Sustained National Effort

Advocacy must be directed to national and local policy makers to elicit
support and commitment to major health concerns through legislations,
budgetary and logistical considerations.
2. Promoting and Supporting Community-Managed Health Care

The DOH, in promoting community-managed care as a cornerstone to
health, must manifest support to community organizing and organizations,
establish sustainable mechanisms or community-managed financial
schemes and identify and develop indigenous health resources.
3. Increasing Efficiencies in the Health Sector

The DOH will safeguard and strengthen the integration of health
operations to maintain the quality o health care. It will make use of devolution
and decentralization of organizations, appropriate technology, development
of human resources, and provide support and assistance to public and
private institutions for enhanced health education.
4. Advancing Essential National Health Research

Essential National Heal Research (ENHR) is an integrated strategy for
organizing and managing research using intersectoral, multi-disciplinary and
scientific approach to health programming and delivery.
Essential ELEMENTS of Primary Health Care:
Education concerning prevailing health problems and the methods of identifying,

preventing and controlling them.
- promotes the partnership of both the family members and the health worker in
the promotion of health as well as prevention of illness
- a means of improving the health of the people

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Locally endemic disease prevention and control
- Endemic diseases may have a low morbidity rate but since it is continually
present in the community, prevention and control is necessary
Expanded program of immunization against major infectious diseases

- This program exists to control the occurance of preventable illness especially of
children.
- The Expanded Program on Immunization (EPI) was established in 1976 to
ensure that infants/children and mothers have access to routinely
recommended infant/childhood vaccines. Six vaccine-preventable diseases
were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus,
pertussis and measles. They are given for free by the government and an
on-going program of the DOH
Maternal and child health care including family planning

- the maternal and infant mortality and morbidity rates are among the indicators
of health of a particular community.
- the protection of the mother and child to illness and other risks would ensure a
good health for the community.
Essential drugs arrangement

- focuses on the information campaign on the proper utilization and acquisition of
drugs.
Nutritional food supplement, an adequate supply of safe and basic nutrition

- malnutrition is one of the problems that we have in the country.
- if food is properly prepared, then one may be assured of a healthy family.
Treatment of communicable and non-communicable disease and promotion of

mental health
- Most communicable diseases that affects the country are also preventable
- Through a comprehensive mental health program, the DOH hopes to attain the
highest possible level of health for the nation including mental health
Safe water and sanitation

- Presidential Decree No. 856/Code on Sanitation of the Philippines empower the
Department of Health with the following powers and functions: Undertake the
promotion and preservation of the health of the people and raise the health
standards of individuals and communities throughout the Philippines.

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Management of PHC
Planning
Set a direction and determine what needs to be accomplished
Setting priorities and determining performance targets
Organizing
Designing the organization or the specific division, unit, or service
Determining positions, teamwork assignments, and distribution of authority and
responsibility.
Staffing
Acquiring and retaining human resources
Developing and maintaining the workforce through various strategies and
tactics.
Controlling
Monitoring staff activities and performance and taking the appropriate actions
for corrective action to increase performance.
Directing
Its focus is to initiate action in the organization through effective leadership and
motivation of, and communication with, subordinates.
PHC SUMMARY
WHAT
An approach/partnership/concept
Community based
Kowledgeable response to the interrelated needs of the community
WHY
Making health care accessible, affordable, sustainable on health for

all
Towards self-reliance
Towards development and social transformation
HOW
Partnership and Community participation,

Linkages: intra- and inter-sectoral collaboration
Provision of community services
Use of appropriate technology and organizing

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Levels of Primary Health Care Workers
1. Village or Grassroot Health Workers
- Initial links of the community to health care
- They provide preventive health care measurements and simple curatives to
promote a healthy environment.
- They encourage programs/activities such as food production programs to
improve the socio-economic level of community.
- the first contact of the community.
- They work in liaison with the local health services.
- They include: trained community health workers or health auxiliary
volunteers, or a traditional birth attendant or healers, who provides
elementary curative and health care and measurements that promote a
healthy environment.
2. Intermediate Level Health Workers

- First source of professional health care
- They attend to health problems which are already beyond the competence
of the village workers.
- They provide supervision, training, supplies, and services that provide
support to front-line health workers.
- Thy include: General medical practitioners or residents, Public health nurse,
Midwives, and Sanitary inspectors
3. First-Line Hospital Personnel

- Serve as the backup health service providers when hospitalization is
required
- The intermediate level health workers or village health workers are in close
contact with them.
- They include: Physicians with specialty, Nurses, Dentists, Pharmacists,
Other health professional
DOH's 10 Herbal Medicines

As part of the home elements of the PHC, the Philippine Department of Health
endorsed 10 herbs for use in the community.
Akapulko (Cassia alata/Herpetica alata)
Uses: Anti-fungal: Tinea flava, ringworm, athletes foot, and scabies

Preparation: Fresh, matured leaves are pounded. Apply sap to the affected part
1-2 times a day.

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Ampalaya (Mamordica charantia)
Uses: Diabetes Mellitus (Mild Type 2)

Preparation: Gather and wash young leaves very well. Chop. Boil 6 tablespoons
in 2 glassfuls of water for 15 minutes under slow fire. Do not cover
pot. Cool and strain. Take ⅓ cup, 3x a day after meals.
Note: Young leaves may be blanched/steamed and eaten ½ glassfuls, 2x a
day.
Bawang (Allium sativum)
Uses: To lower choloesterol levels in blood; for hypertension; toothache

Preparation: May be fried, roasted, soaked in vinegar for 30 minutes, or
blanched in boiled water for 5 minutes. Take 2 pieces, 3x a day
after meals.
For toothache: Pound a small piece and apply to affected part.
Caution: Take on a full stomach to prevent stomach and intestinal ulcers
Bayabas/Guavas (Psidium guajava L.)
Uses:
1. For washing wounds - may be used twice a day.
2. For diarrhea - may be taken 3-4 times a day.
3. As gargle and to relieve toothache. Warm decoction is used or gargle.
Freshly pounded leaves are used for toothache.
Instruction: Guava leaves are to be washed well and chopped. Boil for 15
minutes at low fire. Do not cover pot. Cool and strain before use.
Lagundi (Vitex negundo/V. leucoxylon)

a shrub growing in vacant lots and waste land. Matured branches are planted.
The flowers are blue and bell-shaped. The small fruits turn black when ripe. It is
better to collect the leaves when flowers are in bloom.
Uses:
1. Asthma, cough and fever - boil raw fruits or leaves in 2 glasses of water for
15 minutes until the water left is only 1 glass (decoction). Strain. Leaves
should be chopped and the following dosages of the decoction are given
according to age group:
Dried leaves Fresh leaves
Adult 4 tbsp. 6 tbsp.
7-12 yrs. 2 tbsp. 3 tbsp.
2-6 yrs. 1 tbsp. 1½ tbsp.
2. Dysentery, cold and pain in any part of the body as in influenza - boil a
handful of leaves and lowers in water to produce a glassful of decoction.
Adults and children may drink a glassful of decoction 3x a day.

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3. Skin disease (dermatitis, scabies, ulcer, eczema) and wounds - prepare a
decoction of leaves. Wash and clean the skin/wound with the decoction.
4. Headache - crushed leaves may be applied on the forehead.
5. Rheumatism, sprain, contusions, insect bites - pound the leaves and apply
on affected part.
6. Aromatic bath for sick patients - prepare leaf decoction and use for
bathing sick and newly delivered patients.
Niyug-Niyogan (Quisqualis indica)

a vine, which bears tiny fruit that grows wild in backyards. The seeds must come
from mature, dried, but newly opened fruits. Propagates through stem cuttings
about 20 cm in height.
Use: Anti-helmintic - used to expel round worms, which cause ascariasis. The
seeds are taken 2 hours after supper. If no worms are expelled, the dose
may be repeated after one week.
Adult 8-10 seeds
7-12 years 6-7
6-8 years 5-6
4-5 years 4-5
Caution: not to be given to children below four years old.
Sambong (Blumea balsamiera/Conyza balsamifera)

a plant that reaches 1½ to 3 meters in height with rough hairy leaves. Young
plants around mother plant may be separated when they have three or more
leaves.
Uses: Anti-edema, diuretic, anti-urolithiasis - boil chopped leaves in a glassful of

water for 15 minutes until one glassful remains. Cool and strain.
7-12 yrs. ½ of adult dose
Divide decoction into 3 parts. Drink one part 3x a day.
Note: Sambong is not a medicine for kidney infection.
Tsaang Gubat (Carmona retusa)

a shrub with small, shiny, nice-looking leaves that grows in wild, uncultivated
areas anf orests. Mature stems are used for planting.
Uses:
1. Diarrhea - boil following amount of chopped leaves in 2 glasses of water
for 15 minutes until amount of water goes down to 1 glass. Cool and
strain.

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7-12 yrs. 5 tbsp. 6 tbsp.
2-6 yrs. 2½1 tbsp. 3 tbsp.
Divide decoction into 4 parts. Let patient drink 1 part every 3 hours.
2. Stomachache - wash leaves and chop. Boil chopped leaves in 1 glass of
water for 15 minutes. Cool and filter/strain.
7-12 yrs. 1 tbsp. 1½ tbsp.
Ulasimang Bato/Pansit-Pansitan (Paperonia pellucida)

a weed with heart-shaped leaves and grows in shady parts of the garden and
yard
Use: Lower uric acid (rheumatism and gout)

Preparation: Wash the leaves well. One and a half leaves are boiled in two
glassfuls of water over low fire. Do not cover pot. Cool and strain.
Divide into three parts and drink each part three times a day after
meals. May also be eaten as salad. Wash leaves well. Prepare one
and a half cups of leaves (not closely packed). Divide into three parts
and take as salad three times a day.
Yerba Buena (Mentha cordifelia)

a small multi-branching aromatic herb. The leaves are small, elliptical and with
toothed margin. The stem creeps to the ground and develops roots. May also be
propagated through cuttings.
Uses:
1. For pain in different parts of the body as headache, stomachahe - boil
chopped leaves in 2 glasses of water for 15 minutes. Cool and strain.
7-12 yrs. ½ of adult dose
Divide decoction into 2 parts and drink 1 part every 3 hours.
2. Rheumatism, Arthritis and headache - crush the fresh leaves and squeeze
sap. Massage sap on painful parts with eucalyptus.
3. Cough and colds - get about 10 fresh leaves and soak in a glass of hot
water (expectorant). Drink as tea.
4. Swollen gums - steep 6 glasses of fresh plant in a glass of boiling water for
30 minutes. Use solution as gargle.
5. Toothaches -cut fresh plant and squeeze sap. Soak a piece of cotton in
the sap and insert this in aching tooth cavity. Mouth should be rinsed by
gargling salt solution before inserting the cotton. To prepare salt solution:
Add 5 g of table salt to one glass of water.

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6. Menstrual and gas pains - soak a handful of leaves in a glass of boiling
water. Drink infusion. It induces menstrual flow and sweating.
7. Nausea and fainting - crush leaves and apply at nostrils of patients.
Reminders on the Use of Herbal Medicines:

1. Avoid the use of insecticides on plants.
2. Use clay pot and remove the cover while boiling at low heat in cooking the herbal
medicine.
3. Use one kind of herbal plant as needed and prepare as instructed.
4. If ailments are not relieved, or if there is an untoward reaction, stop giving the
herbal medicine and consult a doctor.

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Module 3.4 - The Health Care Process
Introduction
Review: What is Public Health?

 the science and art of preventing disease,prolonging life, and
promoting physical health and efficiency through organized
community efforts
In community involvement, the people in the community share the responsibility to

participate in:
 defining their health and health-related needs and problems
 identifying realistic solutions organizing community or health action
 mobilizing local resources
 providing essential health services
 evaluating the results of health actions
Primary Health Care is usually the first point of contact people have with the health
care system.
The desire to get involved must be generated from within the community. Its
participation entails productive contact between the health service and the people or
specific needs. Health actions must be a response of community to problems that the
people themselves perceives and carried out in a way that is acceptable to them.

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The Health Care Process
Donabedian was an early proponent of the use of the process concept in healthcare.
He identified the importance of looking at the organisational structure and the processes
involved in producing outcomes for the patients.
According to Bergman, Neuhauser, and Provost, “a citizen point of view on the

healthcare system, its processes and their improvement is emphasised. From this point
of view, five main processes are identified: Keeping Healthy, Detecting Health Problems,
Diagnosing Diseases, Treating Diseases and Providing for a Good End of Life. The
citizen should be looked upon as a cocreator of value and improvement of these
processes.”
Keeping healthy (prevention)

 The use of personal improvement projects is a mechanism to improve health at the
individual level.
 However, the healthcare system also has to engage in proactive prevention of
future illness.
 This includes physical fitness, bed nets against malaria, a good diet, clean drinking
water and less use of tobacco; the list goes on.
Detecting health problems

 Proactive outreach on the part of the healthcare system is important
Diagnosing diseases
 This is the process needed to trigger the next process of treatment.
 Timeliness of diagnosis is critical for many disease paths. The healthcare system
provides the knowledge and methods for this process.
Treating diseases
 Curing and caring is at the core of most of today’s discourse on quality
improvement in healthcare.
 Through self-management, the citizen can work as a stronger partner with the
healthcare system to improve this process.
Providing for a good end of life

 For many diseases, ageing is the root cause leading to the deterioration of all
human systems, some slower, some faster.
 The medical specialties are divided by organ/symptom area: the heart, eyes,
hearing, mental health, etc. What is considered good care from a symptom area
specialist may not create a good end of life.
 A holistic point of view is required; therefore, there is a need for more physicians in
the specialty of geriatric care.

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Concepts of Family
What is a Family?
 The basic unit of society
 A primary entitiy of health care or institution responsible for the physical, emotional
and social support of its members.

 Its foundation is marriage (the group which ensures continuity through its
reproductive function and socialization).
Types of Family:
Family of orientation
the family into which you are born, and where one is reared and socialized
Family of procreation
created when you marry or form a significant and lasting bond with another adult
Roles and responsibilities of family members
According to Burgees and Locke (as cited by Medina, 2001), the family is a
group of persons united by ties of marriage, blood, birth or adoptation.
The family unit is incomplete without an adult to guide its members. It is made up
of individuals who perform certain roles which contribute to the system's function as
a whole.
A family role is an expected set of behaviors associated with a particular family

position that can be formal or informal.
Formal roles - recognized by expectations associated with roles
Informal roles - those that are casually acquired within the family
A family consists of the interactions between the mother and father, parents and
children, and siblings, in their respective roles. These roles, guided by culturally
prescribed norms, are made up of specific tasks and responsibilities.
Tatay - “Haligi ng tahanan”
 being the head in authority, his wisdom is well respected
 He’s the breadwinner so the family depends on him for financial support
 he earns the money so that he can provide for the basic needs of the family
including the children's education.
Nanay - “Ilaw ng tahanan”

 the keeper of the home and children
 she serves as mother and teacher, managing the family resources with
care
 she shares the financial struggles of the father, doing jobs to earn
additional income

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Ate, Kuya, Bunso
 Children are expected to show respect to elders and care for their parents
up to their old age and unto death.
A family is composed of two or more people who are emotionally involved

with each other and live in close geographical proximity. They depend on one
another for emotional, physical, and/or financial support. Hence, emotional
connection is established through caring and a commitments to a common purpose,
as parent- child relationships influence a person's concept of self-worth and
capacity to form later relationships.
Tahanan
root word: Tahan
v. magtahan, tumahan (mag-:-um-) to cease or stop crying.
Home: a place of love, comfort, and rest.

The Filipino family serves as a source of refuge.
Family Structure
- refers to the characteristics and the demographics (age, sex, number) of
individual members who make up family units. As a structure, it may be classified
as:
Traditional Family
 Nuclear/Conjugal
 Extended/Consanguineous
Single Parent Families
Alternate Family Structure
Nuclear/Conjugal Family
 consists of a husband and wife, and their children (natural or adopted) who
live in a common household.
 referred to as “mag-anak”, the primary unit and building block in Filipino
Christian family structure.
 Polygamous Family - when nuclear families are united through the
extension of the husband-wife bond as a result of plural marriages
Extended/Consanguineous Family
 a form of combining nuclear units into larger units through the parent-child
relationships.
 composed of two or more residential units of three or more generations.
 part of the extended family are relatives such as aunts, uncles, cousins, and
grandparents.
 the family is more organized with their assigned tasks and obligations, as
relatives are available to give the needed assistance and guidance in
childbearing.

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Single-Parent Families
 Single parents may be never-married, separated, divorced, or widowed.
Alternate Family Structure

 Cohabitating Families
- includes those individuals who choose to live together
 Single persons not living with others - he or she is a part of a family of origin,
usually has a social network with significant others.
 independent young adults who have entered the work force
 the elderly left alone through death of a spouse
Family Stages and Tasks
Beginning Family
- covers the start of marriage to the birth of the first child, including
establishment of a new household and the beginning of a nuclear family
- establishing a mutually satisfying marriage
- relating harmoniously to kin
- making decisions regarding parenthood
Childbearing Family
- begins with the birth of the first child and lasts until the child is 30 months
of age
- integrate infants into a family unit
- accommodate to new parenting and grandparenting roles
- renegotioating marital relationship
Family with pre-school children

- covers the years from the time the oldest child is 2½ years old until the
youngest child is 5 years old
- adapting to critical needs and interests of pre-school children
- meeting the needs of additional children while continuing to meet those of
the firstborn
- coping with parental energy depletion and lack of privacy
Family with school-age children

- the oldest child is 6 years of age until the child turns 13 years of age.
- constructively fitting into the community of families with school-aged
children
- encouraging and supporting children's educational achievements
- meeting the physical health needs of all family members
- maintaining a satisfying marital relationship

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Family with teenagers
- begins when the oldest child is 13 years of age and ends when the
youngest child is 20 years of age or leaves home.
- balancing teenager's freedom with responsibility as thy mature and
emancipate from the family
- parents refocus on midlife marital and career issues
- parents begin a shift toward concern or the older generation
Launching Center Family

- covers between the time the first child leaves home and the last child
leaves home
- releasing young adults into lives of their own with appropriate rituals and
assistance
- maintaining a supportive home base
- building a new life together as a couple
- assisting with aging or ill parents
Middle-aged Family
- this stage refers to the years from the time the last child leaves home to
the retirement or death of one of the spouses
- reinvest in couple identity with concurrent development of independent
interest
- maintaining ties with older and younger generations
- realigning relationships to include in-laws and grandchildren
- deal with disabilities and death of older generation
Aging Family
- this stage lasts form the retirement of one or both members of the couple
through the death of one of the spouses, ending with the death of the
remaining spouse
- shift from work to leisure and semi-retirement or full retirement
- maintaining couple and individual functioning while adapting to the aging
process
- prepare or own death and dealing with the loss of spouse, and /or siblings,
and other peers.
Family Functions
The family functions for the needs of its members and the requirements essential
for the existence of society.They are essential for the biological and psychological
preservation and protection of its members as they provide the basic needs of its
members - food, clothing, shelter, and the needed love, affection and emotional
security.

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1. Affective
- promotes the stability of famiy members be meeting psychological needs.
2. Socialization and social placement

- these will facilitate in the life-long process of learning for the growth and
development of the individual; social control; and transmission of culture.
3. Reproduction
- the family provides recruits for society to ensure the continuity of the
intergenerational family and society through procreation.
4. Economic
- allows the family to acquire and allocate adequate financial resources to
meet their needs.
5. Health Care and Physical Necessities

- Physical care is the provision of basic needs such as food, clothing and
shelter.
- Family health care includes family health and lifestyle practices
Health Care Process for a Family
The family as a unit of care and service has been the domain in community health
care, in context with a larger goal - facilitating the health of the community.
The family is viewed as an aggregate of persons of different ages, their family

development, dynamics, interaction and the health of the family as a whole.
Characteristics of Family as a Patient
1. The family is a product of time and place

Although some sort of family is virtually a universal phenomenon,
the ways in which a family is organized and the societal tasks which
are assigned to it will vary with time and place.
2. The family develops its own lifestyle

Each family develops its own set of values, its own patterns of
behavior, and its own style of life.
3. The family operates as a whole/group.

In business of daily living, the family develops its own ways of
operating. In dealing with common problems, one family may have
developed a pattern of facing the problem as a group, deciding
together what they will do.

21
4. The family accommodates to the needs of the individual.
Each individual is functioning not only as a member of the group
but also as a unique human being, with his own destiny to fulfill. By
some means, each member must assert himself in a way that allows
him to grow and to develop.
5. The family relates to the community.

The family develops a characteristic stance with respect to the
community.
Family based health care process is a client-oriented, systematic and dynamic

approach to scientific problem solving involving a series of dynamic actions for the
purpose of facilitating optimum family functioning. The health care process for a family
compose of the following:
Relating /establishing a good working relationship with the family
Assessment
Planning
Implementing
Evaluating
Relating/establishing a good working relationship with the family

During this phase, the health care worker initiates contact, shows interest
and concern, demonstrates a helpful attitude, sincerity and sensitivity that will
facilitate in maintaining a two-way communication in gaining the family’s trust
and confidence. The role of the community health worker is to act as the family’s
advocate, supportive and understanding the family’s condition - their family
health and illness patterns. Thus, the establishment of the good working
relationship with the family becomes the foundation or all subsequent
actions.
Family Assessment
Assessment is a systematic collection of data to determine the family’s
status and to identify any actual or potential health problems. It includes the
analysis of data to serve as a basis for planning and delivering heath care to the
whole family.
The purpose of family assessment is to determine the level of family
functioning, to clarify family interaction patterns, to identify strengths and
weaknesses, and to describe the health status of the family and its individual
members (Logan & Dawkins, 1986).

22
The health worker must first assess all components of family functioning:
1. Family dynamics
2. Health status of each family member Can be obtained through direct
3. Socio-economic-cultural factors observation, interview,
4. Home living and environmental condition examination and records review
5. Preventive health practices
Upon completion of the data, the health worker compares the information to
documented norms of health and illness.
Characteristics of Health Families who are Functioning Well in Society

(Hanson 2001):
The family…
 Tends to communicate well and listen to all members
 Affirms and supports all of its members
 Values teaching respect for others
 Members have a sense of trust
 Plays together and humor is present
 Members interact with each other, and a balance in the interactions is noted
among the members
 Shares leisure time together
 Has a shared sense of responsibility
 Has traditions and rituals
 Shares religious core
 Honors the privacy of its members
 Opens its boundaries to admit and seek help with problems
Family Assessment Tools:
1. Genogram
- displays pertinent family information in a family tree format that
shows family members and their relationships over at least three
generations (McGoldrick, et al, 1999)
2. Ecomap
- a visual diagram of the family unit in relation to other units or
subsystems in the community. The ecomap presents the nature of
relationship among family member, and between families and the
community.
3. Family APGAR
- a family unit is considered by Smilkstein to be a nurturing unit that
demonstrates integrity in the five components: Adaptability,
Partnership, Growth, Affection and Resolve.This tool is useful in
suggesting areas to be assessed relative to family functioning and
potential areas of family strengths and resources.

23
4. Family Coping Index
- the purpose of this is to provide a basis for estimating the needs of a
particular family.
The health worker must then formulate conclusions about the family needs as he
categorizes the health problems and determine the various levels of family functioning,
to assess why there is a need for care and supervision.
Planning
Involves the formulation of desired family outcomes and identification of
actions to achieve goals. Careful planning builds on the data collection and
diagnosis of the family-based health care process and increase the
probability of successful implementation and evaluation.
Essential components of the plan (Bailon & Maglaya, 1990):
1. Problem definition
2. Goals and objectives of care
3. Plan intervention
4. Plan for evaluating care
Mutual goal setting in which the client and the family are included is the cornerstone of
effective planning. The family is more likely to work towards the goals they have chosen
and support.
Implementation/Intervention
Implementing is a systematic approach to actions used in partnership
with the family to achieve desired family outcomes. Implementation of a plan
can be accomplished easily I the family agreed on the plan out o support or
each other.
Three levels of family functioning:
Cognitive interventions
- pertains to the act of knowing, perceiving, or understanding,
e.g. teaching a client or family member about the importance of a
diabetic diet
Affective interventions
- related to feelings, attitudes and values,
e.g. helping family members to understand their fears about a
loved one’s diagnosis of diabetes
Behavioral interventions
- refers to skills and behavior modification,
e.g. teaching clients about giving themselves insulin injections and
beginning a group exercise program or newly diagnosed diabetic
clients.

24
Three types of interventions (Freeman and Heinrich (1981):
Supplemental intervention
- doing things that the target client cannot do. This may refer to
giving therapeutic care to the sick or organizing a health care
program.
Facultative intervention
- minimizing, if not removing the obstructions to health care. For
instance, if the family has inadequate information about a particular
health concern, the health care worker provides the needed
information.
Behavioral/developmental intervention
- allows the nurse to motivate families to make responsible decisions
for themselves.
Evaluation
Evaluation has a profound effect on the quality of care in family based
nursing. It is a mutual continuous process that incorporates reassessment,
and modification of the care plan to determine whether goals and outcome
criteria were stated correctly to permit modification as circumstances change,
and met effectively.
Three approaches to evaluating the quality of health care rendered

(Donabedian, 1982):
Structure
- refers to settings in which care occurs. It includes materials,
equipment, qualification of staff, and organizational structure. This
approach to evaluation is based on the assumption that, given a
proper setting with good equipment, good care will follow.
Process
- refers to whether the care that was given was competent or
preferred. It consists of review of records, focused on whether
documentation was included in the clinical records.
Outcome
- refers to the results of client care and restoration of function
and survival. It includes the sense of change in health status or
changes in health-related knowledge, attitude and behavior. This
can be expressed in terms of mortality, morbidity, and disability
for a given population,specifically in health promotion behaviors
such as weight control, exercise, abstinence from alcohol and
tobacco smoking.

25
References:
Ebuen B. U., et al. (2019). Health Information System for Medical Laboratory Science
David, E. S., Rodolfo, M. J. L. D., Serraon-Claudio, V., Jamorabo-Ruiz, (2007).
Community Health Nursing: An Approach to Families ad Population Groups
Gyuchan Thomas Jun, James Ward, Zoe Morris, John Clarkson, Health care process modelling:
which method when?, International Journal for Quality in Health Care, Volume 21, Issue
3, June 2009, Pages 214–224, https://doi.org/10.1093/intqhc/mzp016
Bergman B, Neuhauser D, Provost L (2011). Five main processes in healthcare: a
citizen perspective BMJ Quality & Safety 2011;20:i41-i42.
Resource Manual for Health Care I and Health Care II
Online References:
https://www.who.int/gender-equity-rights/knowledge/right-to-health-factsheet/en/
https://www.who.int/health-topics/primary-health-care#tab=tab_1
https://www.who.int/news-room/fact-sheets/detail/primary-health-care
https://openi.nlm.nih.gov/detailedresult?img=PMC2738304_IJCCM-12-67-g001&query=
&req=4
https://qualitysafety.bmj.com/content/qhc/20/Suppl_1/i41.full.pdf
http://3.bp.blogspot.com/-z9hNqZzeucc/TZKsQ3eYtJI/AAAAAAAAABQ/X8eyIijRZEs/s1
600/genogram+1.jpg
https://i.ytimg.com/vi/ED0WWi67bpM/maxresdefault.jpg
https://ferrisintroductiontosocialwork.pressbooks.com/app/uploads/sites/64471/2017/08/i
mage-1-2.png
https://image2.slideserve.com/4581670/filipino-family-apgar-part-i-l.jpg
https://imgv2-1-f.scribdassets.com/img/document/47339664/original/735bc9c61a/14865
16131
https://image.slidesharecdn.com/207528705-family-case-study-1-150911133137-lva1-a
pp6892/95/207528705-familycasestudy1-14-638.jpg?cb=1441979220

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Community and Public Health

for Medical Laboratory Science (MLS

THE PHILIPPINE HEALTH CARE

Module no. 3 | The Philippine Health Care Delivery System

Module 3.3 - Primary Health Care

Module 3.2 - The National Health Plan

Module no. 3 | The Philippine Health Care Delivery System

Review: What is Health?

The Alma-Ata Declaration

Primary Health Care (PCH)

Module no. 3 | The Philippine Health Care Delivery System

Primary Health Care Paradigm

Rationale for the Development of PHC

A health system based on primary health care will:

Module no. 3 | The Philippine Health Care Delivery System

1. Health and development are interrelated

Development is a quest or an improved quality of life for all.

Thus, the interrelationship of health and development.

MAN AS A FACTOR OF PRODUCTION

PRODUCTION HEALTH AND

GOODS AND SERVICES

THE POVERTY AND ILLNESS CURVE

INCAPACITY AND SHORTER LIFE

HIGH EXPENSES IN CURATVE

Module no. 3 | The Philippine Health Care Delivery System

3. Genuine people's participation is essential

Part of the people's participation is the partnership between the

Other Principles of Primary Health Care:

1. Improvement in the level of health care of the community.

Module no. 3 | The Philippine Health Care Delivery System

Ultimate goal of PHC: SELF-RELIANCE

Major Strategies of Primary Health Care:

1. Elevating Health to a Comprehensive and Sustained National Effort

2. Promoting and Supporting Community-Managed Health Care

3. Increasing Efficiencies in the Health Sector

4. Advancing Essential National Health Research

Essential ELEMENTS of Primary Health Care:

Education concerning prevailing health problems and the methods of identifying,

Module no. 3 | The Philippine Health Care Delivery System

Expanded program of immunization against major infectious diseases

Maternal and child health care including family planning

Essential drugs arrangement

Nutritional food supplement, an adequate supply of safe and basic nutrition

Treatment of communicable and non-communicable disease and promotion of

Safe water and sanitation

Module no. 3 | The Philippine Health Care Delivery System

Making health care accessible, affordable, sustainable on health for

Partnership and Community participation,

Module no. 3 | The Philippine Health Care Delivery System

2. Intermediate Level Health Workers

3. First-Line Hospital Personnel

DOH's 10 Herbal Medicines

Akapulko (Cassia alata/Herpetica alata)

Uses: Anti-fungal: Tinea flava, ringworm, athletes foot, and scabies

Module no. 3 | The Philippine Health Care Delivery System

Uses: Diabetes Mellitus (Mild Type 2)

Bawang (Allium sativum)

Uses: To lower choloesterol levels in blood; for hypertension; toothache

Bayabas/Guavas (Psidium guajava L.)