Module 7

OVERVIEW OF HEALTH PLANNING

Health Planning is an orderly process of defining the community health problem,
identifying unmet needs, and surveying the resources to meet them, establishing priority
goals that realistic and feasible and projecting administrative action to accomplish the
purpose of the proposed program.
Health planning for and with the community is an essential component of community
health nursing practice. The term health planning seems simple, but the underlying
concept is quite complex. Like many of the other components of community health
nursing, health planning tends to vary at the different aggregate levels.
Health planning with an individual or a family may focus on direct care needs or self-
care responsibilities. At the group level, the primary goal may be health education, and,
at the community level, health planning may involve population disease prevention or
environmental hazard control.
 
Purpose of Planning:
 To match the limited resources with many problems
 To eliminate wasteful expenditure and avoid duplication
 To develop the best course of action to accomplished a defined objective
 
The plan for Nursing action or care is based on the actual and potential problems that
were identified and prioritized.
 
Planning nursing actions include the following:
 Goal Setting (SMART- specific, measurable, attainable, realistic, time-bound)
 Constructing a plan of action
 Developing an operational Plan
Bases for developing a community health plan
1.Health status
2.Health resources
3.Health action potential
 
Steps in making a plan: the planning cycle
1.The prioritized conditions or problems
  Analyze the health situation
2.The goals and objectives of nursing care
 Establish objectives and goal
3.The plan of interventions
 Assessment of resources
 Fixing priorities
 Writing up formulate plan
 Programming and implementation
4.Plan for evaluating care
 
HEALTH PLANNING MODEL
 aims to improve aggregate health and applies the nursing process to the larger
aggregate within a systems framework.
 corporate into a health planning project, the model can help students view larger
client aggregates and gain knowledge and experience in the health planning
process. Nurses must carefully consider each step in the process, using this
model
1. Assessment
2. Specify the aggregate level for study (e.g., group, population group, or
organization). Identify and provide a general orientation to the aggregate (e.g.,
characteristics of the aggregate system, suprasystem, and subsystems). Include
the reasons for selecting this aggregate and the method for gaining entry.
 
Describe specific characteristics of the aggregate.
Sociodemographic characteristics: Including age, sex, race or ethnic group, religion,
educational background and level, occupation, income, and marital status.
Health status: Work or school attendance, disease categories, mortality, health care
use, and population growth and population pressure measurements (e.g., rates of birth
and death, divorce, unemployment, and drug and alcohol abuse). Select indicators
appropriate for the chosen aggregate.
 Suprasystem influences: Existing health services to improve aggregate health and the
existing or potential positive and negative impact of other community-level social system
variables on the aggregate. Identify the data collection methods.
 Provide relevant information from the literature review, especially in terms of the
characteristics, problems, or needs within this type of aggregate. Compare the
health status of the aggregate with similar aggregates, the community, the state,
and the nation.
  Identify the specific aggregate’s health problems and needs based on
comparative data collection analysis and interpretation and literature review.
Include input from clients regarding their need perceptions. Give priorities to
health problems and needs, and indicate how to determine these priorities.
During the needs assessment, four types of needs should be assessed.
 The first is the expressed need or the need expressed by the behavior. This is
seen as the demand for services and the market behavior of the targeted
population.
 The second need is normative, which is the lack, deficit, or inadequacy as
determined by expert health professionals.
 The third type of need is the perceived need expressed by the audience.
Perceived needs include the population’s wants and preferences.
 The final need is the relative need, which is the gap showing health disparities
between the advantaged and disadvantaged populations (Issel, 2009).
 
Finally, the nurse must prioritize the identified problems and needs to create an effective
plan. The nurse should consider the following factors when determining priorities:
 
 Aggregate’s preferences
 Number of individuals in the aggregate affected by the health problem
 Severity of the health need or problem
 Availability of potential solutions to the problem
 Practical considerations such as individual skills, time limitations, and available
resources
 
1. Planning
Select one health problem or need, and identify the ultimate goal of intervention. Identify
specific, measurable objectives as mutually agreed upon.
Describe the alternative interventions that are necessary to accomplish the objectives.
Consider interventions at each system level where appropriate (e.g., aggregate system,
supersystem, and subsystems). Select and validate the intervention(s) with the highest
probability of success. Interventions may use existing resources, or they may require
the development of new resources.
 
The nurse should determine which problems or needs require intervention in
conjunction with the aggregate’s perception of its health problems and needs, and
based on the outcomes of prioritization. Then the nurse must identify the desired
outcome or ultimate goal of the intervention.
For example, the nurse should determine whether to increase the aggregate’s
knowledge level and whether an intervention will cause a change in health behavior.
It is important to have specific and measurable goals and desired outcomes. This will
facilitate planning the nursing interventions and determining the evaluation process.
 
Planning interventions is a multistep process
First, the nurse must determine the intervention levels (e.g., subsystem, aggregate
system, and/or supersystem). A system is a set of interacting and interdependent parts
(subsystems), organized as a whole with a specific purpose. Just as the human body
can be viewed as a set of interacting subsystems (e.g., circulatory, neurological,
integumentary), a family, a worksite, or a senior high-rise can also be viewed as a
system. Each system then interacts with, and is further influenced by, its physical and
social environment, or suprasystem (for example, the larger community).
Second, the nurse should plan interventions for each system level, which may center on
the primary, secondary, or tertiary levels of prevention. These levels apply to
aggregates, communities, and individuals.
 
 Primary prevention consists of health promotion and activities that protect the
client from illness or dysfunction.
 Secondary prevention includes early diagnosis and treatment to reduce the
duration and severity of disease or dysfunction.
 Tertiary prevention applies to irreversible disability or damage and aims to
rehabilitate and restore an optimal level of functioning. Plans should include
goals and activities that reflect the identified problem’s prevention level.
Third, the nurse should validate the practicality of the planned interventions according to
available personal as well as aggregate and supersystem resources. Although teaching
is often a major component of community health nursing, the nurse should consider
other potential forms of intervention (e.g., personal counseling, policy change, or
community service development). Input from other disciplines or community agencies
may also be helpful.
Finally, the nurse should coordinate the planned interventions with the aggregate’s input
to maximize participation.
 
Goals and Objectives
 Development of goals and objectives is essential. The goal is generally where
the nurse wants to be, and the objectives are the steps needed to get there.
 Measurable objectives are the specific measures used to determine whether or
not the nurse is successful in achieving the goal.
  The objectives are instructions about what the nurse wants the population to be
able to do. In writing the objectives, the nurse should use verbs and include
specific conditions (how well or how many) that describe to what degree the
population will be able to demonstrate mastery of the task.
 The objectives may be used to later measure learning outcomes, but the
objectives need to be measurable. Objectives may also be referred to as
behavioral objectives or outcomes because they describe observable behavior
rather than knowledge.
 
III. Intervention
 
Implement at least one level of planned intervention when possible.
If intervention was not implemented, provide reasons.
 
IV. Evaluation
 
Evaluate the plan, objectives, and outcomes of the intervention(s). Include the
aggregate’s evaluation of the project. Evaluation should consider the process, product,
appropriateness, and effectiveness.
Make recommendations for further action based on the evaluation, and communicate
these to the appropriate individuals or system levels. Discuss implications for
community health nursing.

Philippine Health Care Delivery System

 
The Philippine health care system has rapidly evolved with many challenges through
time. Health service delivery was devolved to the Local Government Units (LGUs) in
1991, and for many reasons, it has not completely surmounted the fragmentation issue.
The Philippines, the health system is a complex, multi-layered system in which
responsibilities in the health care sector are fragmented Responsibility is shared
between the central government (the Ministry of Health), and Local Government Units
that have full autonomy to organize and finance their ‘own’ regional
 
DEPARTMENT OF HEALTH
The Department of Health develops and approves state quality standards and clinical
protocols, and is responsible for the organization and implementation of the mandatory
accreditation of health care facilities and the issuing of licenses
Local Government Units such as provincial governments are tasked with providing
primary and secondary hospital care, while city and municipal governments are tasked
with providing primary health care, promotive and preventive health programs and basic
ambulatory clinical care
 
Vision — The DOH envisions Filipinos as among the healthiest people in Southeast Asia by
2022, and in Asia by 2040.
Mission — The DOH shall lead the country in the development of a productive, resilient,
equitable, and people—centered health system.
Core Values —- The DOH shall embody at all times integrity, excellence, and compassion
in carrying out its tasks and responsibilities.
 
Categories of Health Care Delivery
Municipal facilities mainly provide primary care services in health centres.
Provinces provide primary-level care in infirmaries and secondary-level care in district
hospitals (Level 1) and provincial hospitals (Level 2). Cities provide primary and
secondary services; however, a few large cities may operate tertiary-level hospitals
(Level 3).
 The DOH operates tertiary-level hospitals in the NCR as well as in the various regions
of the country.
There are other National Government agencies that run tertiary hospitals, including the
military and the University of the Philippines

Level
Type Services Example Location
Prevention
PRIMARY Common
        Primary
                Health Education RHU
       
health Prevention:
        Immunization City health
       
problems
Health Unit
        Chemoprophylaxis
Health
        Promotion
Community
       
Education Personality
       
Illness Hospitals
development
Preventive
        Prevention
Care         personal hygiene
responsible
       
sexuality
         fertility regulation
avoidance of
       
allergens, poisons
and carcinogens
Through
environmental
control:
        safe water
        food hygiene
safe excreta
       
disposal
proper refuse
       
management
safe home
       
environment
        safe workplace
        Prompt Treatment

Secondary
       
        Contact Tracing
Prevention         Case Finding District/
       
Provincial
SENCONDAR        Medical Diagnosis Screening
        Hospitals
Y Services Treatment Multi-phasic
        City
       

Complication screening Hospitals

Prevention         Surveillance
 
Tertiary
        Regional
       
Advance and
        Prevention         Physical Therapy Specialized
Specialized Medical and
TERTIARY Disability Facilities
Medical         National
Prevention Employment 
Services Health
Rehabilitation Centers
  
HEALTH FACILITIES
The Local Government Code of 1991 resulted in the devolution of health services to
local government units (LGUs) that included among others the provision, management
and maintenance of government health facilities (district hospitals, provincial hospitals,
RHUs, BHS) at different levels of LGUs.

Classification of Hospitals
a. Classification of Hospitals According to Ownership:
 Government - Created by law. May be under DOH, DND, DOJ, PNP, LGU,
SUCs, GOCC and others. 
o The Department of Health directly supervises and controls the
management and operations of 66 hospitals. All administrative
regions in the country have DOH hospitals, 38 of which are located
in Luzon, 12 in Visayas, and 16 in Mindanao. Majority of these
facilities are Level 3 Hospitals (56%).
o In addition, there are four specialty hospitals attached to the DOH
operating as Government-Owned and -Controlled Corporations
(GOCC) namely, National Kidney and Transplant Institute,
Philippine Heart Center, Philippine Children’s Medical Center and
Lung Center of the Philippines. Moreover, there are two extension
hospitals, one hospital is currently operating as a Program
Management Office (Philippine Cancer Center), and four hospitals
that are transitioning operations from their respective local
governments to the DOH
 Private - May be a single proprietorship, partnership, corporation,
cooperative, foundation, religious, non-government organization and
others
o The private sector consists of thousands of for-profit and nonprofit
health providers, which are largely market-oriented and where
health care is generally paid for through user fees at the point of
service.
o The private health sector is regulated by the Government through a
system of standards and guidelines implemented through the
licensure procedures of the DOH and the accreditation procedures
of PhilHealth.
o Private sector provides also medical tourism, mostly for low cost
aesthetic and dental procedures.
b. Classification of Hospitals According to Functional Capacity:
 General Hospital - Provides medical and surgical care to the sick and
injured and maternity care and shall have as minimum, the following
clinical services: medicine, pediatrics, obstetrics and gynecology, surgery
and anesthesia, emergency services, out-patient and ancillary services.
 Specialty Hospital - Specializes in a particular disease or condition or in
one type of patient.
 c. Classification of Hospitals According to Trauma Capability: Guidelines formulated
by PCS
 Trauma-Capable Facility - A DOH licensed hospital designated as a
trauma center.
 Trauma-Receiving Facility - A DOH licensed hospital within the trauma
service area which receives trauma patients for transport to the point of
care or a trauma center. 
Classifications of General Hospitals:
a. Level 1
b. Level 2
c. Level 3

Classification of Other Health Facilities:

a. Primary Care Facilities
b. Custodial Care Facilities
c. Diagnostic/ Therapeutic Facility
d. Specialized Out-Patient Facility

2 divisions:
 FORMAL PRIVATE SECTOR- consists of clinics, infirmaries, laboratories,
hospitals, drug manufacturers and distributors, drugstores, medical supply
companies and distributors, health insurance companies, health research
institutions and academic institutions offering medical, nursing, midwifery, and
other allied professional health education.
 NON-FORMAL HEALTH SERVICE PROVIDERS - include traditional healers
(herbolarios) and traditional birth attendants (hilots), which are not covered by
any licensing or accreditation system by the Government.
 
 
 
Health Human Resource
The health human resources are the main drivers of the health care system and
are essential for the efficient management and operation of the public health system.
They are the health educators and providers of health services.
The Philippines has a huge human reservoir for health. However, they are
unevenly distributed in the country. Most are concentrated in urban areas such as Metro
Manila and other cities.
 As of April 2020, there were approximately 14.8 nurses per 10,000 population in
the Cordillera Administrative Region (CAR) of the Philippines. In comparison, there
were only 3.8 nurses per 10,000 inhabitants in the Bangsamoro Autonomous Region in
Muslim Mindanao (BARMM).

MILLENNIUM DEVELOPMENT GOALS 

The Millennium Development Goals (MDGs) are part of the Millennium Declaration by
189 countries, including 147 Heads of State, in September 2000. The goals and targets
are inter-related and should be viewed as a whole.

Built on the outcomes of the international conferences of the 1990s, the Millennium
Declaration marked a strong commitment to the right to development, to the eradication of
the many dimensions of poverty, and to gender equality and the empowerment of women.
The Declaration mainstreams into the global development agenda eight mutually
reinforcing goals, to be achieved by 2015, that are driving national development and
international cooperation.

MDG 1: Eradicate Extreme Poverty and Hunger

The targets are to halve, between 1990 and 2015:

 the proportion of the population whose income is less than one US dollar a day
(nowadjusted to one US dollar and twenty-five cents)
 the proportion who suffer from hunger
 to achieve a full and productive employment and decent work for all, including
women and young people

Result: The probability of halving the proportion of the population whose incomes are
below the official poverty lines, between 1991 and 2015, is medium or average. So are
the two indicators of hunger. The chance of achieving the target is high for the
proportion of the population whose incomes are below the food threshold.

MDG 2: Achieve Universal Primary Education

 target is to ensure that by 2015, children everywhere, boys and girls alike, will be
able to complete a full course of primary schooling
Result: the likelihood of meeting the targets as reported by Bautista (NAST, 2010)  is
low
  

MDG 3: Promote Gender Equality and Empower Women

 Eliminating gender disparity in primary and secondary education, preferably by
2005, and in all levels of education by 2015
Result: The Philippines, one of two countries in Asia to have closed the gender gap
in both education and health is one of only eleven in the world to have done so.
 

MDG 4:  Reducing child mortality

MDG 4, which has for its goal the reduction of child mortality by two-thirds
between 1990 and 2015, has three indicators:
(1) under-five mortality rate which is the probability of dying between birth and
the fifth birthday;

(2) infant mortality rate which is the probability of dying before the first birthday;
and

(3) the proportion of one-year-old children immunized against measles.

Result: The latest data from the 2013 round of the National Demographic and Health
Survey (NDHS) revealed that the under-five mortality rate stood at 31 per thousand live
births as against the 48 deaths per 1,000 live births reported in the 1998 NDHS.

Significant reduction in child mortality has been made due to intensified government
programs on health, and the adoption of the life cycle approach in ensuring continuum
of care. 

According to the 2013 NDHS data, the goal of reducing the under-five mortality rate to a
level of 26.7 deaths per 1,000 live births is likely to be achieved in 2015. The goal for
reducing the IMR to 19 infant deaths per 1,000 live births is also achievable by 2015.

The Department of Health (DOH) strategies for achieving MDG 4 include:

 skilled birth attendance;
 essential newborn care;
 integrated management of sick children;
 micronutrient supplementation;
 immunization;
  breastfeeding;
 birth spacing.

 MDG 5: Improving maternal health

 By 2015, the goal of reduction of the maternal mortality ratio, MMR, between
1990 and 2015, that is, from a level of 209 in 1990 to 52 deaths per 100,000 live
births in 2015
 
Result: The 2011 Family Health Survey (FHS) disclosed that the MMR rose
to 221 deaths from 162 in the preceding five years and 172 10 years earlier. 
But the increase is not statistically significant as the values are within the 95
percent confidence interval, signifying that the MMR has not varied during the 15-
year period.
 One of the targets of MDG 5 is to achieve universal access to reproductive health
by 2015 which is indicated by the contraceptive prevalence rate (CPR), targeting
80% use of contraceptives.

Result: 2013 only 38 % is using contraceptives; 18% using traditional methods. Not

Achieved
 Antenatal care from a health professional is important in order to monitor the
risks associated with pregnancy and delivery for the mother and her child.
Antenatal care is most beneficial in preventing negative pregnancy outcomes
when it is sought early in the pregnancy and continued through to delivery. 
 The DOH recommends that all pregnant women have at least four ANC visits
during each pregnancy. The 2013 NDHS disclosed that close to seven out of
eight women (84 percent) who had a live birth in the five years preceding the
survey had the recommended number of ANC visits during the pregnancy for the
last live birth. One in eight (12 percent) mothers made fewer than four visits while
two out of a hundred had one visit and double that proportion, none at all.
 The high MMR levels can be attributed to delays in (1) deciding to seek medical
care; (2) reaching appropriate care; and (3) receiving care at health facilities.
  Mothers do not seek help from health facilities because of lack of funds, lack of
transportation, no information on PhilHealth insurance benefits, and unavailability
or inaccessibility of health facilities.
 
MDG 6: Combat HIV/AIDS, Malaria and Other Infectious Diseases
 HIV/ AIDS target to decrease the morbidity of AIDS by year 2015

Results: the likelihood of the target for HIV/AIDS being attained is very low
  MALARIA target is to decrease the morbidity and increase the use of
insecticide-treated bed nets (ITN) coverage in children under 5 years of age.

Result: continuous decline of Malaria Case in the Ph

 TUBERCULOSIS target is to increase disease detection and decrease mortality case

Result: continuous decline of TB cases and death

MDG 7: Ensure Environmental Sustainability

targets include:
 integrating the principles of sustainable development into country policies and
programs and reverse the loss of environmental resources
 halve, by 2015, the proportion without sustainable access to safe drinking water
and basic sanitation
 by 2020, to have achieved a significant improvement in the lives of at least 100
million slum dwellers
Result: No enough data.
 

FOURMULA ONE FOR HEALTH

Goals:
 Better health outcomes
 More responsive health system
 Equitable health care financing

Four Components:
 Financing
 Regulation
 Service Delivery
 Governance

SERVICE DELIVERY

Goal:
 Improve accessibility and availability of basic and essential health care for all,
especially the poor.

Strategies:
1) Making available basic and essential health service packages by designated
providers in strategic locations

2) Assuring the quality of both basic and specialized health services

3) Intensifying current efforts to reduce public health threats

Components:
1. Public health investment plan
2. a) Disease-free zones
3. b) Intensified disease programs
4. c) Improving reproductive health outcomes
5. d) Intensified promotion of healthy lifestyle

 
1. Health facilities investment plan
2. a) Critical upgrading of facilities through fund pool
3. b) Rationalizing services in DOH-retained, local government, and private
facilities inside the 16 sites
4. c) Integrating wellness services in hospitals

REGULATIONS

Strategies:

1) Harmonizing & streamlining of systems, processes for licensing & accreditation &
certification

2) Developing a seal of approval

3) Pursuing cost recovery with income retention for health regulatory agencies & other
revenue generating mechanisms

4) Ensuring access of the poor to essential health product

GOVERNANCE

Goal:

Improved health system performance at the national and local level

 Components:

Sectoral Development Approach for Health

Health Human Resource Masterplan

Establishment of 4-in1-Convergence Sites

Philippine Health Information System

Procurement and Logistics Management System

FINANCE

Rationalization of Sources of Health Financing:

 Out-of-Pocket- Shift of OOP to outpatient care (e.g check-up, consultation, etc)
 Local Government- Focus subsidy on preventive and promotive health services
 National Government- Shift resources on regulation, governance and to
teaching/training tertiary hospitals
 Social Health Insurance- Focus on in-patient care

Strategies for Local Government:

 Direct subsidy to priority health programs versus SHI premium
 Management/coordination of LGU health fund
 Revenue-enhancement measures
 Efficient and equitable allocation
 Performance based-budgeting system

Strategies for PHIC:

 Increase membership and collections
 Enhance benefit package
 Improve utilization of reimbursements
 LGU assistance
 Enhance systems for regulation and governance

FOURMULA 1PLUS : F1+

With the aim of attaining the goals outlined in the Philippine Development Plan
2017-2022, Ambisyon Natin 2040, and the Sustainable Development Goals, and
building on the concept of F0URmula One for Health 2005-2010, the medium-term
strategic framework for 2017—2022
expands the four pillars of health reforms and highlights greater focus on performance
accountability towards the Filipino people, thus, FOURmula One Plus for Health or F1+,
with its tagline “Boosting Universal Health Care”.

All DOH offices, units, hospitals, and attached agencies shall align their policies,
programs, and activities to the F1 Plus for Health. Policies, programs and activities that
are adherent to the F1 Plus for Health are to be levelled-up and enhanced. They shall
advocate as well for the F1 Plus for Health to all stakeholders and partners.

Guidelines for F1+

1. Fl+ for Health shall organize critical initiatives in health into four strategic pillars,
namely: Financing, Regulation, Service Delivery, Governance, plus a cross
cutting initiative on Performance Accountability.
2. The implementation of Fl+ for Health shall focus on sustainable, manageable,
and critical interventions that optimize available resources, supported by
evidence and sufficient groundwork, and produce tangible results that are felt by
Filipinos.
3. The reforms shall be implemented under the concept of a whole-of—society,
whole-of government, and whole-of—system approach that encompasses the
entire health sector and other social determinants impacting health

Goals: The F1+ for Health aims to ensure better health outcomes, a more responsive health
system, and a more equitable health care financing.

Strategic Pillars: The DOH shall organize health sector initiatives into four (4) pillars:
 Financing
 Service Delivery
 Regulation
 Governance, plus a cross-cutting initiative on Performance Accountability.

STRATEGIC PILLAR 1: FINANCING

Objective - The objective of the financing pillar is to secure sustainable investments to
improve health outcomes and ensure efficient and equitable use of health resources.
 Efficiently mobilize and equitably distribute more resources for health

 Rationalize health spending

o National resources allocated for financing medical services
for the poor and vulnerable (e.g., PCSO, PAGCOR, DSWD
Medical Assistance, etc.) shall be consolidated into a single
fund to prevent overlaps of financing, and provide easier
access by the poor
 Focus financial resources towards high impact interventions
o basic and essential primary care services; health services
and programs for the poor, marginalized and vulnerable;
o programs and services to achieve the Sustainable
Development Goals, Philippine Development Plan, and
AmBisyon Natin 2040.

STRATEGIC PILLAR 2: SERVICE DELIVERY

Increase access to quality essential health products and services
 A comprehensive essential health service package for all life stages and
specialized health services shall be made available through designated health
providers in strategic locations.
 Implementation strategies to reduce public health threats shall be intensified
through:
o
 disease-free zone initiatives for diseases targeted for elimination as
public health problems;
 disease prevention and control strategies for endemic
communicable, non-communicable, and emerging and reemerging
diseases;
 disease surveillance and monitoring strategies;
 health promotion and communication strategies;
 resilient health systems and provision of essential health goods and
services during times of disasters and emergencies
Access to quality diagnostic and therapeutic products and services shall be ensured by:

o engaging pharmacies to provide selected essential medicines to specific
population groups under a revitalized Botika ng Bayan program;
 o capacitating local health centers to ensure access to basic laboratory
services; and iii. facilitating access to quality and affordable health
products and medicines (i.e., promotion of generics)
Ensure equitable access to quality health facilities
 Upgrading of existing and constructing new health facilities based on a
comprehensive needs assessment of service delivery networks (SDNs)
 compliance of health facilities to accepted standards of care and clinical practice
guidelines
 Facilities for step-down and chronic care, and synergies are being developed
Ensure equitable distribution of human resources for health (HRH)
 HRH requirements commensurate to the needs of the population shall be
mapped and aligned with the strategies for expanding health facilities.
 Other government agencies (such as CHED, TESDA, and PRC) and professional
societies shall be engaged to ensure adequate production of quality HRH
especially in health professions with insufficient supply, and to attain a high level
of competency and ethical standards in the practice of the health professions.
 Equitable distribution of HRH shall be assured through competitive compensation
and benefit packages, and good working conditions for those assigned in
geographically isolated and disadvantaged areas (GIDAs)
 Engage SDNs to deliver comprehensive package of health services
o Public and private providers shall be organized into SDNs that will be
responsible for the health needs of a defined population, including GIDAs.
o All families and individuals shall be assigned to a primary care provider in
the SDN.
o Gatekeeping mechanisms at the primary level of the SDN shall be
strengthened.
o Two-way referral mechanisms at all levels of the SDN shall be
strengthened through an effective and efficient information,
communication, and transport system.

STRATEGIC PILLAR 3: REGULATION

Objective - The objective of the regulation pillar is to ensure high quality and affordable
health products, devices, facilities and services.
Harmonize and streamline regulatory systems and processes
 Mandates and enforcement mechanisms to regulate health facilities, products
and services, including emerging technologies, systems, and processes shall be
expanded and strengthened
 Third party accreditors shall be engaged to improve accountability and
performance of health care providers
  The public and consumers shall be informed and educated on the safety quality,
and prices of health goods and services.
 Develop innovative regulatory mechanisms for equitable distribution of
quality and affordable health goods and services
o Network licensing and network accreditation of
health facilities shall be adopted

STRATEGIC PILLAR  4: GOVERNANCE

 Strengthen sectoral leadership and management
o Participatory governance shall be fostered
in the health sector through community and
patient engagements, public-private
partnerships, and citizen’s charters
 Improve organizational development and performance
o Competency-based learning and development interventions
linked to succession planning shall be implemented at all
levels of the public health system
 Improve processes for procurement and supply chain management to ensure
availability and quality of health commodities
o Electronic procurement and logistics IT system shall be
institutionalized at all levels (e.g., tagging of commodities
with barcodes, QR codes).
 Ensure generation and use of evidence in health policy development, decision
making, and program planning and implementation
o A culture of research and evidence use shall be instilled in
the DOH and its attached agencies

“PL US”: Performance Accountability across all Pillars

Objective- The objective of the Performance Accountability initiative is to use systems

that would drive better execution of policies and programs in the DOH while ensuring
responsibility to all stakeholders.
 Institute transparency and accountability measures at all levels
 Shift to outcome-based management approach
 Regular monitoring and performance reviews and assessments shall be

Module 9
 Program Implementation Phase

 
PROGRAM IMPLEMENTATION
 Implementation is putting the plan into actions and actually carrying out the activities
delineated in the plan, either by nurse or other professionals. It is the action phase of the
nursing process.
 Program implementation is the set of activities done to provide the interventions via the
structure developed to do so.
 Implementation begins after finalizing the program goals and objectives, as well as the
details and logistics about how the intervention will be provided.
 
PARTICIPANTS, RECIPIENTS, TARGETS
Implementation begins with the recruitment and enrollment of program participants or recipients.

Actual recipients of the program are those who receive the intervention; 

 Recipients is a more appropriate terminology when the intervention occurs at the
population level and individuals receive the intervention without having to take any
action, as would be the case in health policy or environmental change.
Participants actively partake in the intervention
 Participants actively make a choice to be involved in the intervention and need to take
some action to receive the intervention, whether that is scheduling a home visit or going
to a grief management support group.
Program targets are those for whom the program is intended. 
 These distinctions become helpful in determining numbers used as numerators and
denominators to calculate program reach, as well as over-inclusion and under-inclusion
of individuals in the program
 Implementation of a program often involves a number of individuals with different
supportive skills and knowledge. The one who delivers the intervention must be trained
and qualified to do so, whether that is a lay person or a licensed health professional
(RN or licensed clinical social worker).
 That person or team of professionals is expected to provide the intervention as developed
and refined during the planning phase.
 The maximum benefit would be achieved by following the procedure that details how the
intervention is to be delivered.
 Inputs that might be needed to provide the intervention include:

o human resources (i.e., staff, volunteers, administrative personnel)

o physical resources (i.e., room, chairs, sphygmometer, handouts)
o money resources
 o marketing resources, managerial resources
o operational or procedure manual
o information systems resources
 The amount of each of these resources that is needed will be determined by the scope,
duration, and intensity of the intervention and overall size of the program
structure.
 
IMPLEMENTATION MONITORING AND EVALUATION
 The old adage that nothing goes as planned applies to health programs. Thus, some
attention must be given to how the program and the intervention are being implemented.
 
Different approaches:
 
Implementation documentation
 simplest approach, which refers to tallying a count of the different activities and
processes done to implement the program.
 Implementation documentation provides information regarding how much of what was
done, but not on the quality of those activities.
 It includes a count of participants or recipients. The objectives guide which activities are
tallied for implementation documentation.
 It is the least expensive and the least intrusive approach.
 
Implementation assessment
 more informative approach is which occurs nearly in real time and is an ongoing act of
gathering data about the implementation.
 referred to as process monitoring in some program planning literature
 The purpose of an implementation assessment is to determine whether timely corrections
or modifications are required regarding the way in which the program is delivered or
which resources are needed for the program.
Implementation evaluation
 It determines both the extent to which the program and its interventions were delivered as
designed and whether variations in the intervention delivery might alter the program
effect,
 Implementation evaluation, often referred to as process evaluation,involves systematic
research and answers the questions regarding to what extent the program was delivered as
intended and to which segments of the target audience.
 Implementation documentation, assessment, and evaluation can be done by trained staff,
with much of the data collection integrated into routine information gathering about who
participated and what was done.
  Once the data have been converted into a format for ease of inspection, such as graphs,
charts, and tables, various stakeholders can assist in interpreting the data, particularly
with reference to the objectives.
 They can also make recommendations for improving the implementation of the
intervention. For most programs, implementation monitoring activities will continue for
the duration of the program, whether that is weeks or decades.
 Importantly, nurse contribute to the scientific literature about program implementation.
demonstrated nurse have contributed to the science of health program development,
implementation, and monitoring.
 One example of implementation assessment is the study conducted by Goulet et al.
(2009) regarding a program to prevent shaken baby syndrome. They assessed patients’
perceptions of nurses’ skill and comfort with the program interventions and of the
intervention format. They then used those data to determine how best to improve the
program and the intervention delivery.

Module 10

ADOLESCENT HEALTH AND DEVELOPMENT PROGRAM

The Adolescent Health and Development Program (AHDP) targets adolescents aged
10-19 years. It is mainly guided by the Convention on the Rights of Children which
states that the program must be in the best interests of the child. Based on the
Department of Health (DOH) Administrative Order (AO) 2013-0013 or the National
Policy and Strategic Framework on Adolescent Health and Development Administrative
Order, the program primarily aims to provide adolescents access to quality healthcare
services This means increased accessibility of adolescent-friendly facilities, programs,
and health providers for the Filipino youth.
Vision
 The AHDP envisions a country with well informed, empowered, responsible and
healthy adolescents who are leaders in the society
Mission
 Its mission is to ensure that all adolescents have access to comprehensive
health care and services in an adolescent-friendly environment.
Objectives
 Improve the health status of adolescents and enable them to fully enjoy their
rights to health.
Strategies, action Points and Timeline
  Health promotion and behavior change for adolescents
 Adolescent participation in governance and policy decisions
 Developing/transforming health care centers to become adolescent-friendly
facilities
 Expanding health insurance to young people
 Enhancing skills of service providers, families and adolescents
 Strengthening partnerships among adolescent groups, government agencies,
private sectors, Civil Society organizations, families and communities
 Resource mobilization
 Regular assessment and evaluation
Trainings
 Adolescent Health Education and Practical Training (ADEPT)
 Foundational Course (including Healthy Young Ones)
 Healthy Young Ones (HYO) Training
 Adolescent Job Aid (AJA) Training

BARANGAY NUTRITION SCHOLAR (BNS) PROGRAM

Description
The Barangay Nutrition Scholar (BNS) Program is a human resource development
strategy of the Philippine Plan of Action for Nutrition, which involves the recruitment,
training, deployment and supervision of volunteer workers or barangay nutrition
scholars (BNS). Presidential Decree No. 1569 mandated the deployment of one BNS in
every barangay in the country to monitor the nutritional status of children and/or link
communities with nutrition and related service providers. PD 1569 also mandated the
NNC to administer the program in cooperation with local government units.
Objectives
 To be able to deliver nutrition and nutrition-related services to the barangay by
caring for the malnourished and the nutritionally vulnerable, mobilizing the
community, and linkage building
Program Components
 Recruitment: A BNS is a trained community worker who links the community with
service providers, with the following qualifications:
o bonafide resident of the barangay for at least four years and can speak
the local language well;
o possess leadership potentials as evidenced by membership and
leadership in community organizations;
o willing to serve the barangay, part-time or full-time for at least one year;
o at least elementary school graduate but preferably has reached high
school level;
o physically and mentally fit;
o more than 18 years old, but younger than 60 years old.
 Training: Ideally, ten-day didactic training and a 20-day practicum. However, due
to resource constraints this has become various forms, e.g. orientation and on-
the-job training, or 5-day didactic training
 Benefits:
o Monthly travelling allowance
o Entitled to second grade Civil Service Commission (CSC) eligibility after
completing two years of continuous and satisfactory service
o Others, e.g. BNS kit consisting of a bag and other materials related to
performing tasks, e.g. forms; medical assistance and survivorship
assistance
Target Population/ Client
 Children 0-5 years old
 Pregnant and lactating women
 Families with 0-5 years old children and those with pregnant and lactating
women
  Area of Coverage
o Nationwide
 Partner Institutions
o Local Government Units

Policies and Laws

 Presidential Decree No. 1569, “Strengthening the Barangay Nutrition Program by
providing for a barangay nutrition scholar in every barangay, providing funds
therefore, and for other purposes”
 NNC Memorandum No. 2017-011, “Guidelines for providing medical and
survivorship assistance to Barangay Nutrition Scholars (BNS)”
Strategies, Action Points and Timeline
 Capacity building of local government units along providing technical and
administrative support to BNS.
 Annual evaluation of performance of BNSs
 Active pursuit of the amendment of PD 1569 by end of the 17th Congress
 Revision of Guidelines on the Barangay Nutrition Scholars Program by end of
December 2017
Program Accomplishments/ Status
 46, 293 BNS deployed as of August 2017
 23, 444 BNSs provided with travelling allowance in 2016 and 12, 686 as of 31
August 2017
 31 BNSs provided with medical assistance in 2016 and 8 as of 31 August 2017
 33 BNSs provided with survivorship assistance in 2016 and 30 as of 31 August
2017
 Conduct of BNS Conferences every two years since 2011.
 Organization of national and local federation of BNSs
 

BLOOD DONATION PROGRAM

                 Republic Act No. 7719, also known as the National Blood Services Act of
1994, promotes voluntary blood donation to provide sufficient supply of safe blood and
to regulate blood banks. This act aims to inculcate public awareness that blood donation
is a humanitarian act.
                 The National Voluntary Blood Services Program (NVBSP) of the Department
of Health is targeting the youth as volunteers in its blood donation program this year. In
accordance with RA No. 7719, it aims to create public consciousness on the importance
of blood donation in saving the lives of millions of Filipinos.
                 Based from the data from the National Voluntary Blood Services Program, a
total of 654,763 blood units were collected in 2009. Fifty-eight percent of which was
from voluntary blood donation and the remaining from replacement donation. This year,
particular provinces have already achieved 100% voluntary blood donation. The DOH is
hoping that many individuals will become regular voluntary unpaid donors to guarantee
sufficient supply of safe blood and to meet national blood necessities.
Mission:
  Blood Safety
  Blood Adequacy  
  Rational Blood Use
  Efficiency of Blood Services
Goals:
The National Voluntary Blood Services Program (NVBSP) aims to achieve the following:
1. Development of a fully voluntary blood donation system;
2. Strengthening of a nationally coordinated network of BSF to increase efficiency
by centralized testing and processing of blood;
3. Implementation of a quality management system including of Good
Manufacturing Practice GMP and Management Information System (MIS);
4. Attainment of maximum utilization of blood through rational use of blood products
and component therapy; and
5. Development of a sound, viable sustainable management and funding for the
nationally coordinated blood network.
R.A. 7719 - NATIONAL BLOOD SERVICES ACT OF 1994
 An act promoting Voluntary Blood Donation, providing for an adequate supply of
safe blood, regulating blood banks, and providing penalties for violations thereof.
VISION
 Safe Blood For All
MISSION
 A nationally coordinated and efficient networking of BSF based on voluntary blood
donation that will ensure safe, adequate, timely and accessible blood supply and the
 rational use of blood in the Philippines through advocacy, professional education and
research.
GOALS
 Attainment of 100% Voluntary Non- remunerated Blood Donation Worldwide by
2020
 Institutionalized Blood Center Model
 An adequate and sustainable financing for National Voluntary Blood Services
Program and Operations of BSFs.
 A quality management system for the NVBSP and Blood Services Facilities
 Robust, operational and universally accessible Information Management System
 Rational use of blood/ blood products in all transfusing healthcare facilities

Module 11

CHILD HEALTH AND DEVELOPMENT STRATEGIC PLAN YEAR 2001-2004

The Philippine National Strategic Framework for Health and Development for Children
or CHILD 21 is a strategic framework for planning programs and interventions that
promote and safeguard the rights of Filipino children. Covering the period 2000-2005, it
paints in broad strokes a vision for the quality of life of Filipino children in 2025 and a
roadmap to achieve the vision.
              Children's Health 2025, a subdocument of CHILD 21, realizes that health is a
critical and fundamental element in children's welfare. However, health programs cannot
be implemented in isolation from the other component that determine the safety and
wellbeing of children in society. Children's Health 2025, therefore, should be able to
integrate the strategies and interventions into the overall plan for children's
development.
             Children's Health 2025 contains both mid-term strategies, which is targeted
towards the year 2004, while long-term strategies are targeted by the year 2025. It
utilizes a life cycle approach and weaves in the rights of children. The life cycle
approach ensures that the issues, needs and gaps are addressed at the different stages
of the child's growth and development.
                The period year 2002 to 2004 will put emphasis on timely diagnosis and
management of common diseases of childhood as well as disease prevention and
health promotion, particularly in the fields of immunization, nutrition and the acquisition
of health lifestyles. Also critical for effective planning and implementation would be
addressing the components of the health infrastructure such as human resource
development, quality assurance, monitoring and disease surveillance, and health
information and education.
               The successful implementation of these strategies will require collaborative
efforts with the other stakeholders and also implies integration with the other
developmental plan of action for children.
Vision
A healthy Filipino child is:
 Wanted, planned and conceived by healthy parents Carried to term by healthy
mother Born into a loving, caring. stable family capable of providing for his or her
basic needs Delivered safely by a trained attendant
 Screened for congenital defects shortly after birth; if defects are found,
interventions to correct these defects are implemented at the appropriate time
 Exclusively breastfed for at least six months of age, and continued breastfeeding
up to two years Introduced to complementary foods at about six months of age,
and gradually to a balanced, nutritious diet Protected from the consequences of
protein-calorie and micronutrient deficiencies through good nutrition and access
to fortified foods and iodized salt
 Provided with safe, clean and hygienic surroundings and protected from
accidents Properly cared for at home when sick and brought timely to a health
facility for appropriate management when needed. Offered equal access to good
quality curative, preventive and promotive health care services and health
education as members of the Filipino society
 Regularly monitored for proper growth and development, and provided with
adequate psychosocial and mental stimulation Screened for disabilities and
developmental delays in early childhood; if disabilities are found, interventions
are implemented to enabled the child to enjoy a life of dignity at the highest level
of function attainable
 Protected from discrimination, exploitation and abuse
 Empowered and enabled to make decisions regarding healthy lifestyle and
behaviors and included in the formulation health policies and programs Afforded
the opportunity to reach his or her full potential as adult
Current Situation
           Deaths among children have significantly decreased from previous years. In the
1998 NDHS, the infant mortality rate was 35 per 1000 livebirths, while neonatal death
rate was 18 deaths per 1000 livebirths. Among regions IMR is highest in Eastern
Visayas and lowest in Metro Manila and Central Visayas. Death is much higher among
infants whose mothers had no antenatal care or medical assistance at the time of
delivery. Top causes of illness among infants are infectious diseases (pneumonia,
measles, diarrhea, meningitis, septicemia), nutritional deficiencies and birth-related
complications.
             The probability of dying between birth and five years of age is 48 deaths per
1000 livebirths. The top five leading causes of deaths (which make up about 70%) of
deaths in this age group) are pneumonia, diarrhea, measles, meningitis and
malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and vehicular
accidents.
             The decline in mortality rates may be attributed partly to the Expanded Program
of Immunization (EPI), aimed to reduce infant and child mortality due to seven
immunolabel diseases (tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis,
Hepatitis B and measles).
           The Philippines has been declared as polio-free during the Kyoto Meeting on
Poliomyelitis Eradication in the Western Pacific Region last October 2000. This.
however, is not a reason to be complacent. The risk of importing the poliovirus from
neighboring countries remains high until global certification of polio eradication. There is
an urrgent need for sustained vigilance, which includes strengthening the surveillance
system, the capacity for rapid response to importation of wild poliovirus, adequate
laboratory containment of wild poliovirus materials, and maintaining high routine
immunization until global certification has been achieved.
               Malnutrition is common among children. The 1998 FNRI survey show that
three to four out of ten children 0-10 years old are underweight and stunted. The
prevalence of low vitamin A serum levels and vitamin A deficiency even increased in
1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation
coverage reached to more than 90%, however, a downward trend was evident in the
succeeding years from as high as 97% in 1993 to 78% in 1997.
             Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in
rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from
13.2% to 20% among children 4-5 mos of age (NDHS).
             Several strategies were utilized to improve child health. The Integrated
Management of Childhood Illness aims at reducing morbidity and deaths due to
common childhood illness. The IMCI strategy has been adopted nationwide and the
process of integration into the medical, nursing, and midwifery curriculum is now
underway.
             The Enhanced Child Growth strategy is a community-based intervention that
aims to improve the health and nutritional status of children through improved caring
and seeking behaviors. It operates through health and nutrition posts established
throughout the country.     
Goal
 The ultimate goal of Children's Health 2025 is to achieve good health for all
Filipino children by the year 2025.
 Medium-term Objectives for year 2001-2004
o Health Status Objectives
 Reduce infant mortality rate to 17 deaths per 1,000 live births
 Reduce mortality rate among children 1-4 years old to 33.6% per
1000 livebirths
 Reduce the mortality rate among adolescents and youths by 50%
o Risk Reduction Objectives
 Increase the percentage of fully immunized children to 90%
  Increase the percentage of infants exclusively breastfed up to six
months to 30%
 Increase the percentage of infants given timely and proper
complementary feeding at six months to 70%
 Increase the percentage of mothers and caregivers who know and
practice home management of childhood illness to 80%
 Reduce the prevalence of protein-energy malnutrition among
school-age children
 Increase the health care-seeking behavior of adolescents to 50%
o Services and Protection Objectives
 Ensure 90% of infants and children are provided with essential
health care package
 Increase the percentage of health facilities with available stocks of
vaccines and essential drugs and micronutrients to 80%
 Increase the percentage of schools implementing school-based
health and nutrition programs to 80%

 Increase the percentage of health facilities providing basic health

services including counseling for adolescents and youth to 70%
Strategies and Activities
 Enhance capacity and capability of health facilities in the early recognition,
management and prevention of common childhood illness
o This will entail improvements in the flow of services in the implementing
faciities to ensure that every child receive the essential services for
survival, growth and development in an organized and efficient manner.
Facilities should be equipped with the essential instruments, equipment
and supplies to provide the services. Health providers shall have the
knowledge and skills to be able to provide quality services for children.
Existing child health policies, guidelines and standards shall be reviewed
and updated, and new ones formulated and disseminated to guide health
providers in the standard of care.
 Strengthening community-based support systems and interventions for children's
health
o Notable community-based projects and interventions, such as the health
and nutrition posts, mother support groups, community financing schemes
shall be replicated for nationwide implementation. Model building and
dissemination of best practices from pilot sites has proven effective in
generating support and adoption in other sites. More of these shall be
initiated particularly for developing interventions to increase care-seeking
and prevention of malnutrition in children.
 Fostering linkages with advocacy groups and professional organizations and to
promote children's health
  Collaboration with the nongovernment sector and professional groups shall:
 Conduct national campaigns on children's health
 Conduct and support national campaigns for children
 Initiate and support legislations and researches on children's health and welfare
 Development of comprehensive monitoring and evaluation system for child
health programs and projects
 

DENTAL HEALTH PROGRAM

Oral disease continues to be a serious public health problem in the Philippines. The
prevalence of dental caries on permanent teeth has generally remained above 90%
throughout the years. About 92.4% of Filipinos have tooth decay (dental caries) and
78% have gum diseases (periodontal diseases) (DOH, NMEDS 1998). Although
preventable, these diseases affect almost every Filipino at one point or another in his or
her lifetime.
              In general, tooth decay and gum diseases do not directly cause disability or
death. However, these conditions can weaken bodily defenses and serve as portals of
entry to other more serious and potentially dangerous systemic diseases and infections.
Serious conditions include arthritis, heart disease, endocarditis, gastro-intestinal
diseases, and ocular-skin-renal diseases. Aside from physical deformity, these two oral
diseases may also cause disturbance of speechsignificant enough to affect work
performance, nutrition, social interactions, income, and self-esteem.            
              Poor oral health poses detrimental effects on school performance and mars
success in later life. In fact, children who suffer from poor oral health are 12 times more
likely to have restricted-activity days (USGAO 2000). In the Philippines, toothache is a
common ailment among schoolchildren, and is the primary cause of absenteeism from
school (Araojo 2003, 103-110). Indeed, dental and oral diseases create a silent
epidemic, placing a heavy burden on Filipino schoolchildren.
VISION
   Empowered and responsible Filipino citizens taking care of their own personal
oral health for an enhanced quality of life
MISSION
 The state shall ensure quality, affordable, accessible and available oral health
care delivery.
GOAL
 Attainment of improved quality of life through promotion of oral health and quality
oral health care.     
OBJECTIVES AND TARGETS:
 The prevalence of dental caries is reduced         
o Annual Target: 5% reduction of the prevalence rate every year
 The prevalence of periodontal disease is reduced
o Annual Targets: 5% reduction of the prevalence rate every year
 Dental caries experience is reduced
o Annual Target: 5% reduction of the mean dmft/DMFT for 5/6 years old and
12 years old children every year
 The proportion of Orally Fit Children (OFC) 12-71 months old is
increased                       
o Annual Targets: Increased by 20% yearly        

             The national government is primarily tasked to develop policies and guideline

for local government units. In 2007, the Department of Health formulated the Guidelines
in the Implementation of Oral Health Program for Public Health Services (AO 2007-
0007). The program aims to reduce the prevalence rate of dental caries to 85% and
periodontal disease by to 60% by the end of 2016. The program seeks to achieve these
objectives by providing preventive, curative, and promotive dental health care to
Filipinos through a lifecycle approach. This approach provides a continuum of quality
care by establishing a package of essential basic oral health care (BOHC) for every
lifecycle stage, starting from infancy to old age.
            The following are the basic package of essential oral health services/care for
every lifecycle group to be provided either in health facilities, schools or at home.

TYPES OF SERVICE
LIFECYCLE
(Basic Oral Health Care Package)

Mother(Pregnant  Oral Examination

Women) **  Oral Prophylaxis (scaling)
 Permanent fillings
 Gum treatment
  Health instruction

 Dental check-up as soon as the first tooth erupts

Neonatal and Infants
under 1 year old**  Health instructions on infant oral health care and
advise on exclusive breastfeeding

 Dental check-up as soon as the first tooth appears

and every 6 months thereafter
 Supervised tooth brushing drills
 Oral Urgent Treatment (OUT)

Children 12-71 months               - removal of unsavable teeth

old     **               - referral of complicated cases
              - treatment of post extraction complications
              - drainage of localized oral abscess
 Application of Atraumatic Restorative Treatment   
(ART)

 Oral Examination
 Supervising tooth brushing drills
School Children (6-12  Topical fluoride therapy
years old)  Pits and Fissure Sealant Application
 Oral Prophylaxis
 Permanent Fillings

 Oral Examination
Adolescent and Youth  Health promotion and education on oral hygiene,
(10-24 years old)** and adverse effect on consumption of sweets and
sugary beverages, tobacco and alcohol

 Oral Examination
Other Adults (25-59  Emergency dental treatment
years old)  Health instruction and advice
 Referrals

 Oral Examination
 Extraction of unsavable tooth
Older Person (60 years
old and above)**  Gum treatment
 Relief of Pain
 Health instruction and advice
 
STRATEGIES AND ACTION POINTS:
 Formulate policy and regulations to ensure the full implementation of OHP
 Establishment of effective networking system (Deped, DSWD, LGU, PDA, Fit for
School, Academe and others)
 Development of policies, standards, guidelines and clinical protocols 
o Fluoride Use
o Toothbrushing
o Other Preventive Measures
 Ensure financial access to essential public and personal oral health services
 Develop an outpatient benefit package for oral health under the NHIP of the
government
 Develop financing schemes for oral health applicable to other levels of care ( Fee
for service, Cooperatives, Network with HMOS)
 Restoration of oral health budget line item in the GAA of DOH Central Office
 Provide relevant, timely and accurate information management system  for oral
Health.
 Improve existing information system/data collection (reporting and recording
dental services and accomplishments)
o setting of essential indicators
o development of IT system on recording and reporting oral health service
accomplishments and indices
o Integrate oral health in every family health information tool, recording
books/manuals
 Conduct Regular Epidemiological Dental  Surveys – every 5 years 
 Ensure access and delivery of quality oral health care servicesa.
 Upgrading of facilities, equipment, instruments, supplies
 Develop packages of essential care/services for different groups (children,
mothers and marginalized groups)  
o revival of the sealant program for school children
o toothbrushing program for pre-school children
o outreach programs for marginalized groups
 Design and implement grant assistance mechanism for high performing LGUs 
o Awards and incentives
o Sub-allotment of funds for priority programs/activities
 Regular conduct of consultation meetings, technical updates and program
implementation reviews with stakeholders
  Build up highly motivated health professionals and trained auxiliaries to manage
and provide quality oral health care
 Provision of adequate dental personnel
 Capacity enhancement programs for dental personnel and non-dental personnel
 Current FHSIS Indicators/parameters:
1. Orally Fit Child (OFC)– Proportion of children 12-71 months old and are orally fit
during a given point of time. Is defined as a child who meets the following
conditions upon oral examination and/or completion of treatment a) caries- free
or carious tooth/teeth filled either with temporary or permanent filling materials, b)
have healthy gums, c) has no oral debris, and d) No handicapping dento-facial
anomaly or no dento-facial anomaly that limits normal function of the oral cavity
2. Children 12-71 months old provided with Basic Oral Health Care (BOHC)
3. Adolescent and Youth (10-24 years old) provided with Basic Oral Health care
(BOHC)
4. Pregnant Women provided with Basic oral Health Care (BOHC)
5. Older Persons 60 years old and above provided with Basic Oral Health Care
(BOHC)
 Policy/Standards/Guidelines formulated/developed:
1. AO. 101 s. 2003 dated Oct. 14, 2003 – National Policy on Oral Health
2. AO 2007-0007 – Dated January 3, 2007 Guidelines In The Implementation Of
Oral Health Program For Public Health Services In The Philippines
3. AO 4-s.1998 – Revised Rules and Regulations and Standard Requirements for
Private School Dental services in the Philippines
4. AO 11-D s. 1998 – Revised Standard Requirements for Hospital Dental services
in the Philippines
5. AO 3 s. 1998 - Revised Rules and Regulations and Standard Requirements for
Occupational Dental services in the Philippines
6. AO 4-A s. 1998 – Infection Control Measures for Dental Health Services
 Trainings/Capacity Enhancement Program:
 Basic Orientation Course on Management of Public Health Dentist
o The training program was designed with the Public Health Dentists (PHDs) as the
main recipients of the Basic Course on the Management of Oral Health
Program.  The training is expected to provide an in-depth understanding of the
different roles and functions of the PHDs in the management and delivery of
Public Health Services. A training module was developed for the basic course.
 
 GARANTISADONG PAMBATA
The Mandate: A.O. 36, s2010
 Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos
Goal
 Achievement of better health outcomes, sustained health financing and
responsive health system by ensuring that all Filipinos, esp. the disadvantaged
group (lowest 2 income quintiles) have equitable access to affordable health care
Universal Health Care Strategies:
 Financial risk protection.
 Improved access to quality hospitals and facilities
 Attainment of health-related MDGs by:
 Deploy CHTs to actively assist families in assessing and acting on their health
needs
 Utilize life cycle approach in providing needed services: FP, ANC, FBD, ENC,
IPP, GP for 0-14 years old
 Aggressive promotion of healthy lifestyle change
 Harness strengths of inter-agency and intersectoral cooperation with DepEd,
DSWD and DILG
EXPANDED GARANTISADONG PAMBATA
Comprehensive and integrated package of services and communication on health,
nutrition and environment for children available every day at various settings such as
home, school, health facilities and communities by government and non-government
organizations, private sectors and civic groups.
Objectives:
 Contribute to the reduction of infant and child morbidity and mortality towards the
attainment of MDG 1 and 4.
  Ensure that all Filipino children, especially the disadvantaged group (GIDA), have
equitable access to affordable health, nutrition and environment care. 

Age by
Health  Nutrition Environment
Year

Maternal nutrition
Iron supplementation
Maternal health care Water
Vitamin A
0-1 Essential newborn care Sanitation
Early &exclusive
Immunization breastfeeding Hygiene
Complementary promotion
feeding Oral health
Child injury
Breastfeeding prevention
Complementary Treated bed nets
Immunization
feeding
1-5 Deworming Smoke-free
Vitamin A homes
IMCI
Iron supplementation
Iodized salt at home

Deworming
Proper nutrition
6-10 Booster
Iodized salt at home
immunization (Screening)

Deworming  
Proper nutrition
Booster immunization
11-14 (Screening) Iron supplementation
Physical activity (Healthy Iodized salt at home
lifestyle)

 
Vitamin A Supplementation
 Policy remains the same for giving Vitamin A capsules:
 Routine: every 6 months for 6-59 months preschoolers
 Therapeutic:
 o 1 capsule upon diagnosis regardless of when the last dose of VAC for
preschoolers with measles
o 1 capsule upon diagnosis except when child was given Vitamin A was given less
than 4 weeks for preschoolers with severe pneumonia, persistent diarrhea,
severely underweight   
o 1 capsule immediately upon diagnosis, 1 capsule the next day and another capsule
after 2 weeks after for preschoolers with xerophthalmia
 Recording/Reporting:
o FHSIS Records and Reports
o GP Forms – submitted to NCDPC thru CHDs
o April – preschoolers 6-59 months given   VAC from November of past year
to   April of the current year     October – preschoolers 6-59 months given
o VAC from May to October 

 MAGPASUSO
 (Newborn to 6 mos)  Pasusuhin ng gatas ni Nanay lang
 (6 mos to 2 years old)  Magpasuso  at bigyan ng (mga masustansiyang ibat-
ibang pagkain) ibang pagkain (pampamilyang pagkain).
 Bumili/ Gumamit ng mga produktong may SANGKAP PINOY seal sa pagluluto.
MAGPABAKUNA
 Siguraduhing kumpletoang bakuna ni baby  bago siya magdiwang ng unang
kaarawan.
 Pabakunahan ng MMR ang mga batang 1 taon hanggang  1 taon at 3 buwan. Ito
ay laban sa tigdas, beke at rubella (German Measles)
MAGBITAMINA A
 Siguraduhing mabigyan (mapatakan) ng Bitamina A kada anim (6) na buwan
ang inyong mga anak na edad 6 na buwan  hanggang 5 taon
MAGPURGA
 Siguraduhing mapurga ang inyong mga  anak na edad 1 hanggang 12 na taong 
gulang  kada anim na buwan. 
GUMAMIT NG PALIKURAN
 Gumamit ng kubeta o palikuran sa pagdumi at pagihi. 
 MAGSIPILYO
 Wastong pagsisipilyo ng ngipin ng  dalawang beses sa isang araw, lalo na bago
matulog.
 MAGHUGAS NG KAMAY
  Maghugas ng kamay bago kumain at matapos gumamit ng kasilyas. Ugaliin din
ang paghuhugas ng kamay matapos maglaro o humawak ng maduduming
bagay. 
 

Module 12

EVALUATION 
Evaluation of care with communities seeks to determine whether health has improved. Were the
desired health goals reached? How much progress was made toward the goals? What themes,
patterns, and results emerged? What side effects were evident? How have community
competence and resilience been enhanced? To what extent are the community changes
sustainable? Evaluation provides information to help community/public health nurses improve
the quality of their nursing practice.
 Evaluation is the process by which a nurse judges the value of nursing care that has
been provided. As with any type of nursing care, the community/public health nurse
seeks to determine the degree to which planned goals were achieved and to describe any
unplanned results.
 The purpose of the evaluation is to facilitate additional decision making. An evaluation
might conclude that what had been done could not have been done better, that the goals
were reached, and that the goals were mutually desirable to the nurse and the community
members. 
 This conclusion would be cause for celebration. As a result of another evaluation, the
conclusion might be that alterations are needed in the plan of care to reach the desired
outcomes more effectively; or possibly that, although goals were reached, the cost in
money, time, or other resources was too expensive for the nurse or the community
members.
Evaluation is based on several assumptions: 
 first, that nursing actions have results, both intended and unintended
 second, that nurses are accountable for their own actions and care provided
 third, that different sets of actions result in resources being used differently (i.e., some
nursing interventions use more resources than others).
Evaluation involves two parts: 
 measurement and interpretation. 
  Basic to the nursing process, however, is the idea of measuring whether planned goals
were achieved. Synonyms for this activity and its result are outcome
attainment (Donabedian, 1980), performance evaluation (Suchman, 1967), results of
effort, and evaluation of effectiveness (Deniston & Rosenstock, 1970). The question that
the nurse attempts to answer is, “Were the planned goals achieved?”
Another basic idea addresses the quality of the results and the process that contributed to the
results. Some terms used to express this idea are as follows:
 Appropriate—suitable for a particular occasion or use; fitting
 Adequate—able to fill a requirement; sufficient or satisfactory
 Effective—producing an expected result; productive
Responsibilities of Community/Public Health Nurses
 The responsibilities of community/public health nurses for evaluating nursing care with
communities vary, depending on the size and complexity of the community and whether
the community is geopolitical or phenomenological.
  Community/public health nurses may also work with multidisciplinary teams and nurses
who engage in quality assurance and accreditation reviews (ANA, 2007).
 Regardless of the type or size of community, the members themselves should, when
possible, be involved in planning and conducting the evaluation (ANA, 2007). The
measurement of many health outcomes requires the judgment of the community members
themselves.
Types of Evaluation 
 Formative evaluation: Formative evaluation occurs during program development and
implementation. It provides information on achieving program goals or improving your
program.
 Process evaluation: Process evaluation is a type of formative evaluation that assesses the
type, quantity, and quality of program activities or services.
 Outcome evaluation: Outcome evaluation can focus on short- and long-term program
objectives. Appropriate measures demonstrate changes in health conditions, quality of
life, and behaviors.
 Impact evaluation: Impact evaluation assesses a program's effect on participants.
Appropriate measures include changes in awareness, knowledge, attitudes, behaviors,
and/or skills.
Community Involvement
 Because the community members are involved in evaluation, at least part of the
evaluation must occur in the clients’ community. 
 Mutuality is an important aspect of evaluation. Because much of the impact of the
community/public health nurse is indicated by self-care and lifestyle changes of
community members, a nurse must document and validate outcomes directly with
community members. 
  Additionally, although goals have been achieved, some negative or unexpected results
might also have occurred. The nurse must explore the perceptions of community
members to discover and validate the meaning of the experience. Determining how
satisfied community members are with both the outcomes and the nursing interventions is
important.
 Stakeholders are individuals who have expectations about nursing care but who are not
directly involved in its delivery. 
 For example, there are individuals whose approval was necessary, those who contributed
money or supplies, those who volunteered to assist, and those (such as competitors) for
whom the presence of nursing services had an impact. Community health/public nurses
need to identify the stakeholders and invite them to participate in evaluation.

Standards for a Good Evaluation

Standards for evaluation of nursing care with communities have been formulated by the Quad
Council of Public Health Nursing Organizations and published by the ANA (2007):
 The employing agency is to provide supervision, consultation, and general evaluation
plans for the baccalaureate- prepared community/public health nurse.
 The community members are to participate in the evaluation.
 The nursing care is to be revised based on the evaluation.
 Evaluation is to be documented and disseminated so that the record can strengthen
nursing practice and knowledge.
Steps in evaluation
Evaluation is a process that includes several steps: planning, collecting the data, analyzing and
interpreting the data, providing recommendations, reporting the results, and implementing the
recommendations (McKenzie et al., 2009)
Plan the Evaluation
1. Review goals and objectives.
2. Meet with stakeholders to identify which evaluation questions should be answered.
3. Develop a budget for evaluation.
4. Determine who will conduct the evaluation.
5. Develop the evaluation design: What will be done?
6. Decide which evaluation instruments will be used to collect information.
7. Analyze how the evaluation questions relate to the goals and objectives.
8. Analyze whether the questions of stakeholders are addressed.
9. Determine when the evaluation will be conducted; develop a timeline.
Collect Evaluation Data
1. Develop specific processes for collecting data through questionnaires, review of records
or documents, personal interviews, telephone interviews, and observation.
2. Determine who will collect the data.
3. Pilot the data-collection instruments.
 4. Refine the instruments based on data from the pilot.
5. Identify the sample of persons from whom evaluation data will be collected.
6. Collect the data.
Analyze the Data
1. Determine how the data will be analyzed.
2. Determine who will analyze the data.
3. Analyze the data, generate several interpretations, and make recommendations.
Report the Evaluation
1. Determine who will receive results.
2. Determine who will report the findings.
3. Determine format for the report, including an executive summary.
4. Discuss how the findings will affect the program.
5. Determine which findings will be included in the report.
6. Distribute the report.
Implement the Results
1. Plan how the results will be implemented.
2. Identify who will implement the results.
3. Determine when the results will be implemented; develop a time line.
(From McKenzie, J. F., & Smeltzer, J. L. (1997). Planning, implementing, and evaluating health
promotion programs: A primer (2nd ed.; pp. 276–277). Boston: Allyn and Bacon. Copyright
1997 by Allyn and Bacon.)
 
Questions answered by evaluation
Evaluation of nursing care with communities involves evaluation of programs of care for
populations. 
Program evaluation includes evaluation of outcomes (program goals and outcome objectives), as
well as evaluation of the structures and processes used to achieve the outcomes (Ervin, 2002). 
The ANA considers outcomes, structures, and processes as the primary categories of criteria to
be used to measure the quality of nursing care. Outcomes are the end results; structures are the
social and physical resources; and processes are the “sequence of events and activities” used by
the nurse during the delivery of care. For example, evaluation of a health program designed to
identify adults with high cholesterol levels would include the following:
 Structure standard: Cholesterol screening will be available to all adults, regardless of
whether they can pay for testing.
 Process standard: Cholesterol screening will be performed on all adults who come to the
health screening event.
 Outcome standards:
 o One hundred percent of the adults screened will be given their test results.
o Eighty percent of adults with cholesterol levels above the recommended norm
will follow up with a physician’s visit for evaluation.
Five categories of questions that can be answered by evaluation:
 outcome attainment, also called effectiveness
 appropriateness of care
 adequacy of care in relation to the scope of the problem
 relationship of resources to results, also called efficiency
 process. 
 

Variable Questions Examples of Measurement

Numbers and rates of children

 Did change occur?
immunized
 To what degree was
progress made toward Numbers of cases of cancer found on
Outcome the goal? Papanicolaou smears
attainment  What are actual effects Changes in attitudes regarding people
on clients?  with acquired immunodeficiency
 What unintended syndrome (AIDS)
outcomes occurred? Reduction in teenage pregnancy rate

 Did the goals fit the

Plan of care compared with clinical
need?
nursing knowledge
 Are the goals and plans
acceptable to the Community preferences
Appropriateness community?
 Are the plans likely to
achieve the goals?
 Does the plan duplicate Plan of care is evidence-based
existing efforts?

 Rate of effectiveness multiplied

 What degree does the by number of people exposed
intervention meet the to service
Adequacy total amount of need?  Outcomes relative to total
 Were some people not needs in population
served?  Degree to which need was a
priority
 Efficiency  What resources were
 Relation of effort to outcome
used?

 What did nurses do?

When? Where?
 Number of clinics/or
 How many people were encounters/week or month
reached?
 Number of home visits
Process  What were the reasons
 Education content taught and
for the successes or
strategies used
failures?
 Numbers of people attending
 What contributed to the
screening sessions
results? What methods
were used?

 
Evaluation of Outcome Attainment
Evaluation of outcome attainment, also called effectiveness, addresses the results of nursing
interventions. Change toward predetermined goals, as well as unplanned effects, may have
occurred.
Frequently, large health programs are evaluated as a total intervention, without distinguishing the
effects of nursing interventions from the effects of other health disciplines and program
components. 
Therefore, nursing care may be lumped into a single evaluation for the whole program rather
than being evaluated as a separate intervention.
Devising evaluation strategies and criteria for each component of a program is more useful
because evaluators are given a better idea of which strategies are effective and which might need
to be revised or eliminated. Evaluators can then determine nurse-sensitive outcomes. 
Evaluation of outcome attainment evaluates changes in the population, the health care system
within the community, or the environment. 
Possible Outcome Measures
1. Knowledge
2. Behaviors, skills
3. Attitudes, commitment to action
4. Emotional well-being
5. Health status (epidemiological measures)
6. Presence of health care system services and components
7. Satisfaction or acceptance regarding the program interventions
8. Presence of policy that allows, mandates, or funds
9. Altered relationship with physical environment
When evaluating the health of a community, more than the outcomes of the population must be
considered. Because the interaction of people in their environment facilitates or hinders health,
variables such as the presence of health services, the satisfaction and acceptance of such
programs, the presence of policies, and a harmonious balance with the environment must also be
considered.
Knowledge
A great deal of client teaching and health education is evaluated by measuring the health-related
information that the individual, group, or population has obtained. 
When evaluating populations, surveys may be used to determine knowledge about specific
health-related topics. These surveys may be conducted as interviews or through written
questionnaires (Polit & Beck, 2010). 
When working with populations, the community/public health nurse is interested in the
proportion of the population that the teaching reached and the proportion that retained the
information presented. 
Behaviors and Skills
Integrating health-related behaviors and skills into daily living affects health status—raising
children, caring for an older bed-bound family member, seeking a prostate examination, and
preparing nutritious foods require action. These actions are labeled competent or skilled if they
are consistent with existing knowledge and if they are performed in an effective and efficient
manner.
Health behaviors may change as a result of interventions performed by community/public health
nurses 
When evaluating health behaviors of populations, the nurse’s interest is in the proportion of the
population who engage in such behaviors. The usual way to collect information about health
behaviors is to ask people what they do. 
Some data on health behaviors, such as use of a specific health service, can also be collected
from client health records and health care information systems
Time and money often limit the degree to which behavior change can be measured. 
Observing the behavior of populations helps confirm the accuracy of what is reported; however,
this process takes much more time and money. Asking people to make a contract with
themselves to make a commitment to specific actions has been shown to increase the likelihood
that the actions will be performed (Sloan & Schommer, 1991). 
Attitudes
Attitudes include opinions and preferences about ideas, people, and things. Persons have
attitudes about the concept of health and the ways in which health may be attained and
maintained. Because attitudes predispose the selection of some actions over others, attitudes are
a health-related measure. 
Community attitudes also predispose the population to support or work against various policies
and services. 
If the predominant community attitude is that health prevention can reduce human suffering and
dollars spent for care of the ill, there may be more support for prison health services.
Attitudes toward health and health behavior can be changed through planned or spontaneous
experiences. Attitudinal change is also called emotional learning or affective learning. 
Attitudes of populations can be measured before and after an intervention to determine whether
affective learning has occurred. Changes in attitude may predispose people to change their
behaviors. 
Emotional Well-Being and Empowerment
Emotional well-being in a population can be measured by the proportion of members who
experience self-esteem and satisfaction with their lives. Emotional well-being of a community
can be measured also by assessing the existing structures and processes to strengthen human
development and connectedness.
Improved quality of life is another outcome related to human well-being.
Criteria for emotional well-being of a community also include the degree of acceptance and
cohesion among members and patterns of support, socialization, and decision making. When
community members participate in the decision making that leads to goal achievement,
perceptions of self-efficacy are enhanced. 
Self-efficacy is the belief that an individual can influence his or her environment and
circumstances. Self-efficacy contributes to self-concept and is necessary if community members
are to have an impact on their health.
Health Status
An ultimate measure of the effectiveness of health services and programs is the health status of
the population. Community/public health programs seek to reduce premature deaths, disabilities,
and injuries. 
Health status is measured using epidemiological statistics about morbidity and mortality.