LESSION 1: FRAMEWORK OF CHN HEALTH – state of complete physical, social, mental well-

Community Health Nursing – Utilization of the nursing being, not merely the absence of disease.
process in different levels of clienteles in which it is OPTIMUM LEVEL OF FUNTIONING (OLOF) – DOH health
concerned with the promotion of health and prevention of care delivery system; includes promotive, preventive, curative
disease, disability and rehabilitation. and rehabilitative care.

4 CLIENTELES OF CHN: ECOSYSTEM INFLUENCES OF OLOF

- Individual - Political
- Family - Socio-economic
- Population/Group/Aggregates - Environment
- Community - Behaviour/lifestyle
- Heredity
PHILOSOPHY OF CHN: CHN is based on the worth and - Health care delivery system
dignity of man.
DETERMINANTS OF HEALTH
ROLES OF COMMUNITY HEALTH NURSES: - Income and social status
1. CARE PROVIDER – direct care to client. - Education
2. CLINICIAN – direct care to disabled and sick. - Physical environment
3. HOSPICE CARE PROVIDER – care to terminally ill - Employment and working conditions.
patient. - Culture
4. EDUCATOR – health teaching for increased client - Genetics
knowledge. - Personal behaviour and coping skills.
5. COUNSELOR – listening and providing feedback. - Health services
6. CHANGE AGENT – both teaching and counselling. - Gender
7. ADVOCATE – working on client’s behalf of self-
determination. PUBLIC HEALTH NURSING – synthesis of public and
8. ROLE MODEL – being what is taught to client. nursing practice. A field of practice in which practice,
9. HEALTH MENTOR – detecting deviations. interpersonal, analytic and organization skills are applied to
10. COORDINATOR – collaboration. health problems as they affect the community.
11. ORGANIZER – ensuring max participation. - WHO – CHN is a special field of nursing that
12. MANAGER – different management function. combines skill of nursing and public health nursing.
13. SUPERVISOR – administrative support. - DR. WINSLOW – CHN is a science and art of
14. TRAINER – providing technical support. preventing disease, prolonging life, and promoting
15. RESEARCHER – conducting studies for improvement. health.
LILIAN WALD – founder of public health nursing.
MAJOR FUNCTIONS AND ACTIVITIES OF CHN - “Denote a service that is available to all people.”
ADMINISTRATION AND MANAGEMENT
- Planning and programming CORE FUNCTIONS
- Oversee of nursing inputs to different programs - Disease control
- Monitoring - Injury prevention
- Coordination - Health protection
- Resources - Health public policy
- Physical facilities - Promotion of health and equitable health gains
- Logistics
TECHNICAL 3 KEYS
- Patient/family health - Health promotion
- Disaster emergency - Health maintenance
- Epidemiology - Disease prevention
- Environmental sanitation
SUPPORTIVE ESSENTIAL PUBLIC HEALTH FUNCTIONS
- Community organization - Health situation monitoring and analysis.
- Health education - Disease prevention and control
- Staff development and training of manpower - Development of policies and planning and public
- Research and development health
- Strategic management of health systems
DOH PUBLIC NURSES FUNTIONS & ACTIVITIES - Regulation and enforcement to protect public health.
- Management - Human resources development, planning in public
- Training health.
- Supervision - Health promotion
- Coordination - Ensuring quality of health services
- Health Education - Research development and implementation of health
- Provision of health and nursing care services

CONCEPTS RELATED TO CHN

CORE FUMCTIONS OF PUBLIC HEALTH
 - Assessment RA 7160 – all allocations to devolve to LGUs to facilitate
- Policy Development health service delivery.
- Assurance
3 MAJOR ROLES
HEALTH PROMOTION – activities that enhance resources - Leadership in health
directing at improving well-being. - Enabler and capacity builder
DISEASE PREVENTION – activities that protect people from - Administrator of specific services
disease and effects of disease.
MILESTONES
3 LEVELS OF PREVENTION - Devolution
1. PRIMARY – present problems before it occurs. - Use of generics
2. SECONDARY – activities provide early intervention. - Milk code
3. TERTIARY – activities that correct disease and - PhilHealth
prevent from further deteriorating. - DOH resources to promote public health.
- Fiscal autonomy to public hospital
LESSON 2: THE PH HEALTH CARE DELIVERY SYSTEM - Good governance programs
WORLD HEALTH ORGANIZATION (WHO) - Funding for UHC
VISION
- A world in which all people attain the highest possible level BASIC HEALTH SERVICES
of health. - Education regarding health
MDG (Millenium Development Goal) & SDG (Sustainable - Local endemic diseases
Dev’t Goal) - EPI
- The anchor of DOH programs in the Philippines. - Maternal and child health services
- Signed by 189 UN members in 2000. - Nutritional health services
- Essential drugs and herbal plants
GOALS: - Treatment of communicable and non-communicable
- Reduced Child Mortality diseases
o EPI – Enhanced Program on Immunization - Sanitation of the environment
o Presidential Decree 996 - Dental health promotion
o 7 vaccines on immunization program - Access and use of hospitals as centre for wellness
- Improved Maternal Health - Mental health promotion
- Combat HIV/AIDS, Malaria and other diseases
WHO BUILDING BLOCKS OF HEALTH SYSTEMS
SDG no. 3 – GOOD HEALTH AND WELL-BEING - Leadership and governance
- With 169 target countries - Service delivery
- 70:100k live births - Health information
- Preventable deaths of children under 5 y/o - Health financing
- End epidemics of AIDS, TB, and other tropical - Human resources
diseases - Medicine and Technologies
- Combat hepatitis, water-borne diseases and other
communicable diseases LESSON 3: UNIVERSAL HEALTH CARE AND PRIMARY
AIMS THAT: In 2020, half the number of global deaths and HEALTH CARE
injuries from road traffic accidents. UNIVERSAL HEALTH CARE – Provision to every Filipino of
highest possible quality of healthcare that is accessible.
PHILIPPINE DEPARTMENT OF HEALTH (DOH) – Is the
institution responsible for health of Filipino people. LEGAL BASIS
- E0 94 – post-war reorganization of DOH and public AO 0036 of 2010 – Aquino Health Agenda
welfare
- National health policy maker and regulatory institution INSTRUMENTS
- National plans, standards, and guidelines of health - Health Financing
- Vision: Filipinos are among the healthiest people in - Service Delivery
SEA by 2022, in Asia by 2040. - Policy, Standards and Regulations
- Mission: to lead the country in the development of a - Governance for Health
productive, resilient, equitable, and people-centred - Human resources for Health
health system. - Health information

TIMELINE: PRIMARY HEALTH CARE – essential health care mode

Jan. 1, 1951 – RA 1082, Rural Health Act of 1954 universally accessible to individuals and families in
Jun. 2, 1978 – DOH to MOH, Sec. Gatmaitan as 1st minister community
Dec. 2, 1982 – EO 851 of Ex. President Marcos Sr.,
combining of public health and hospital operations under
provincial health officers.
Apr. 23, 1987 – EO 119, reorganization from MOH – DOH
Oct. 10, 1991 – RA 7160 – Local Government Code
1994-2004 – Development of health sector reform agenda
DEVOLUTION OF HEALTH SERVICES LEGAL BASIS
EO 851 of 1983 – integrating public health and hospital
services. LEVELS OF HEALTH CARE AND REFERRAL SYSTEM
RA 7160 – Local Government Code 1. PRIMARY LEVEL – 1st contact between members
RA 1988 – Generics Act and health facility
RA 9875 – National Healthcare Insurance Act of 1995 2. SECONDARY LEVEL – given by physicians with
Health Sector Reform Agenda – Battle cry: Kalusugan Para basic health training.
Sa Masa 3. THIRD LEVEL – rendered by specialists, usually
complicated or intensive cases.
RATIONALE
- Magnitude of Health Problems NURSE FUNCTION IN PHC
- Inadequate and unequal distribution of health 1. PROMOTIVE – Assess, educate, promote, mobilize,
problems organize.
- Increasing cost of medical care 2. PREVENTIVE – Identify, mobilize, implement,
- Isolation of health care activities from other manage, supervise.
development 3. CREATIVE – Utilize, identify, defect, educate.
4. REHABILITATIVE – Restore, ensure, prevent.
4 PILLARS OF PHC
- Active involvement PRIMARY HEALTH CARE LADDER/FRAMEWORK
- Support mechanism
- Multi-sectoral linkages NATIONAL HEALTH SERVICES, MEDICAL CENTER,
- Appropriate technology TEACHING AND TRAINING HOSPITALS
REGIONAL HEALTH SERVICES AND REGIONAL
CONCEPT OF PHC: HOSPITALS
- Health is related to social structures. PROVINCIAL/CITY HEALTH SERVICES AND
- Health and development are interrelated. PROVINCIAL/CITY HOSPITALS
- Community organizing is the core of PHC. EMERGENCY / DISTRICT HOSPITALS
- Use appropriate technology. RHU, COMMUNITY HOSPITALS, HEALTH CARE, PRIVATE
CLINICS, AND AND PERICULTURE CENTERS
ELEMENTS/COMPONENTS OF PHC BHS – BASIC HEALTH SERVICES
- Environmental sanitation
- Control of communicable disease
- Immunization
- Maternal and Child health and family planning
- Adequate food and proper nutrition
- Provision of medical care and emergency treatment
- Treatment of locally endemic diseases
- Provision of essential drugs

ESSENTIAL SERVICES – HOME ELEMENTS

H – ospital as center of wellness
O – ral and dental health
M – ental health
E – lderly care

E – ducation for health

L – ocal endemic diseases prevention and control
E – xpanded program on Immunization
M – aternal and child health/family planning
E – ssential drugs provision/herbal medicines
N – utrition
T – reatment of communicable disease
S – afe water and sanitation

DEPENDANTS OF PHC WORKERS

- Available health manpower resources
- Local health needs and problems
- Political and financial feasibility

3 CLASSIFIED LEVELS
1. Village or Grassroot Health Workers – community
worker, health volunteers, traditional birth attendants,
healers
2. Intermediate Level of Health workers – medical
practitioners, resident, public health nurse, midwife
3. Health Personnel of 1st Line Hospital Facility –
back up services – health professionals