COMMUNITY HEALTH AND DEVELOPMENT

What Community Development Is?

Excerpts from the book Health Care Practice in the Community

By Erlinda Palaganas, R.N. Ph.D.

COMMUNITY FRAMEWORK FOR CHN PRACTICE
HEALTH
NURSING
PRACTICE

. Philosophy/beliefs
. Principles
Primary Health Care
Ethicolegal aspects
. Processes
Critical thinking INDIVIDUAL
Nursing Process
Program Planning,
Implementation, HEALTH
and Evaluation.
Management and
supervision
Research
Quality Assurance
Advocacy and Family
political Action
. Roles and Function
Population
Group

HEALTH CARE
DELIVERY Community
SYSTEM

ECONOMIC, SOCIOCULTURAL, POLITICAL

AND ENVIRONMENTAL FACTORS
 PRINCIPLES:

Primary Health Care

Ethicolegal aspects
CONCEPT: PRIMARY HEALTH CARE

HISTORY OF PRIMARY HEALTH CARE

May 1977- The 30th World Health Assembly adopted resolution WHA
30:43. This resolution decided that the main social target of governments and
of WHO should be the attainment by all the people of the world by the year
2000 a level of health that will permit them to lead a socially and
economically productive life.

September 12, 1978- International Conference on Primary Health

Care was held in this year at Alma Ata. USSR
The conference came up with what is known popularly as the Alma Ata
Declaration, which represents a global ideal, a new vision about how to
achieve world health. The Declaration stated that primary health care is the
key to attaining the health-for-all goal.

1979- The World Health Assembly launched the Global Strategy for
Health for all.

October 19, 1979- The President of the Philippines issued Letter of

Instruction 949 which mandated the Ministry of Health to adopt Primary
Health Care as an approach towards design, development, and
implementation of programs, which focus health development at the
DEFINITION OF PRIMARY HEALTH CARE

The Alma Ata Conference defines Primary Health

Care as essential health care based on practical,
scientifically sound and socially acceptable methods
and technology made universally, accessible to
individuals and families in the community by means of
acceptable to the, through their full participation and at
a cost that community and country cam afford to
maintain at every stage of their development in the spirit
of self-reliance and self-determination. It forms as
integral part of both the country’s health system, of
which it is the central function and the main focus, and
of the overall social and economic development of the
community.
GLOBAL GOAL OF PRIMARY HEALTH CARE

The global goal as stated in the Alma Ata

Declaration is Health for All by the year 2000 through
self-reliance.

The Health for All goals does not mean

however that nobody will be sick or disabled
anymore. Nor does it mean that health care
professionals will provide care for everybody in the
country or the world for all their existing ailments.
What it means is that health begins at home, in
schools and in the work place.
PRIMARY HEALTH CARE PRINCIPLES AND STRATEGIES

1. Accessibility, Availability, Affordability and Acceptability of Health Services.

Strategies:
a. Health services delivered where the people are
b. Use of indigenous/resident volunteer health worker as a health care
provider with a ratio of one community health worker per 10-20
households.
c. Use of traditional (herbal) medicine with essential drugs.

2. Provision of quality, basic and essential health services

Strategies:
a. Training design and curriculum based on community needs and
priorities
b. Attitudes, knowledge and skills developed are on promotive,
preventive, curative and rehabilitative health care.
c. Regular monitoring and periodic evaluation of community health
worker performance by the community and health staff.
3. Community Participation

Strategies:
a. Awareness-building and consciousness raising on health and
health- related issues.
b. Planning, implementation, monitoring and evaluation done
through small group meetings (10-20 households cluster)
c. Selection of community health workers by the community.
d. Formation of health committees/
e. Establishment of a community health organization at the parish
or municipal level.
f. Mass health campaigns and mobilization to combat health
problems.

4. Self-Reliance

Strategies:
Community generates support (cash, labor) for health programs
a. Use of local resources (human, financial, material)
b. Training of community in leadership and management skills.
c. Incorporation of income generating projects, cooperatives and
small scale industries.
5. Recognition of the interrelationship of health and development
Strategies:
a. Convergence of health, food, nutrition, water, sanitation and population
services.
b. Integration of PHC into national, regional, provincial, municipal and
barangay development plans.
c. Coordination of activities with economic planning, education,
agriculture, industry, housing, public works, communication and social
services.
d. Establishment of an effective health referral system.

6. Social Mobilization
Strategies:
a. Establishment of an effective health referral system
b. Multi-sectoral and interdisciplinary linkage
c. Information, education, communication support using multi media.
d. Collaboration between government and non-governmental
organizations

7. Decentralization
Strategies:
a. Reallocation of budgetary resources
b. Reorientation of health professionals on PHC
c. Advocacy for political will and support from the national leadership
down to the barangay level.
ESSENTIAL HEALTH SERVICES IN PRIMARY HEALTH CARE

The Alma Ata report on PHC outlined eight essential elements to be

emphasized in PHC. These shall comprise the initial and continuing care at
the point of entry into health system. The list of essential elements is a
modification of the basic health services of earlier times. To facilitate easy
recall of these, the acronym ELEMENTS is used to present these.

1. Education for health

2. Locally Endemic Diseases Control
Malaria, Leprosy, Leptospirosis
3. Expanded Program of Immunization
Poliomyelitis, measles, tetanus, diphtheria and other deadly but
preventable diseases.
4. Maternal and Child Health including responsible parenthood
protection of mother and child against illness and other risks.
5. Essential drugs
Proper utilization and acquisition of drugs
Generic Act of the Philippines Campaign
6. Nutrition
7. Treatment of Communicable and Non-Communicable Diseases.
8. Safe water and sanitation.
ETHICOLEGAL ASPECTS OF NURSING PRACTICE IN THE
COMMUNITY

Guided by a number of legal and ethical principles centered on the

welfare of clients and protection of their rights.
Professional practice is legal if the practitioner works in accordance
with the law.
Ethical practice is characterized by three major principle:
Respect for Autonomy – the ability to decide: adequate information,
intellectual competence; power to act ypon your decision,
and respect for the individual autonomy of others.
- self determination
Beneficence – acts of mercy and charity, to apply measures for the
benefit of the sick.
- maximize the good, minimize harm
Justice – fairness, “ equals must be treated equally and un-equals
must be treated unequally.
- example: distributive justice, compensatory justice

- Bases for Client’s rights and their rights have professional

responsibility.
Other Universal Ethical Principles are:

4.Veracity – in association with truth,

disclose factual information
so that patient can exercise personal
autonomy
5.Nonmaleficence – not to inflict evil or
harm, someway similar to
Beneficence
6.Confidentiality – privacy, important aspect
of trust that patients
place to health professionals
7. Role Fidelity – practice as team
Some Applications:

Right to be informed about condition and treatments,

interventions to be done.

Right to accurate or adequate information to make an

informed decision.
Example: to decide or to refuse treatment.

Right to safe and quality care.

Example: update client on latest development
of health care
Right to privacy

Etc

FINALLY……Do Not only deliver health services but

Humanize the Health Care Delivery System.
Other IMPORTANT CONCEPTS:

C H N is composed of three major concepts:

COMMUNITY (CLIENT)
HEALTH (GOAL)
NURSING (MEANS)

HEALTH
PUBLIC HEALTH
PRIMARY HEALTH CARE
RIGHT TO, AND RESPONSIBILITY FOR HEALTH
RIGHT TO, AND RESPONSIBILITY FOR HEALTH

HEALTH is a basic human right

(Universal Declaration of Human Rights Article 1,
Philippine Constitution and By Laws; Article 13, section 11
“ The state shall adopt an integrated and comprehensive
approach to health development which shall endeavor to
make essential goods, health and other social services
available to all people at affordable cost.

WHO (1995) “ Governments have a responsibility for the

health of their people by providing adequate health and
social measures.
Congressional Commission on Health (1993). Health
as a Fundamental Right, Health deserves to a top national
priority. The state, individuals, families and communities
share the responsibility for health and as responsibility of
all sectors..
POCESSES IN C H N PRACTICE

1.Critical Thinking – Rational examination of

ideas, inferences, assumptions, principles,
arguments, conclusions, issues, statements,
beliefs and action.
• Critical thinking in all of daily living
• Discriminate among the uses and misuses of
language in nursing
• Identify and formulate nursing problems
• Analyze meaning of terms in relation to their
indication, cause or purpose.
• Analyze arguments, issues and conclusions
• Examine nursing assumptions
• Report data and clues accurately
1.Critical Thinking

• Make and check inferences based on data,

make it sure plausible
• Formulate and clarify beliefs
• Verify, corroborate and justify claims, beliefs,
conclusions, decisions and actions
• Give relevant reasons for belief and
conclusions
• Formulate and clarify value judgments
• Seek reasons, criteria and principles that
effectively justify value judgments and
• Evaluate the soundness of conclusions
2. Nursing Process – the means by which nurses
address the health needs and problems of
their clients. It is a logical and systematic
way of processing information gathered from
different sources and translating intentions
into meaningful actions or interventions.

FOUR PHASES: ASSESSMENT, PLANNING,

IMPLEMENTATION AND EVALUATION
3. Management and Supervision – Management
activities depend on the size and level of
autonomy of health center

Example: Organizes nursing service,

manages the RHU
in the absence of the Physician.
:Supervises the Rural Health
Midwives.
:many more.
4. Research in Community Health

Purposes:
1. improve our understanding of clients
and their specific context

2. provide date needed for program and

policy development and evaluation

3. improve the delivery of health services

and implementation

4. improve cost-effectiveness of
programs

5. project a good image of nurses

5. Quality Assurance

Characteristics:

appropriate health services are available and accessible

health care is effective, desired outcomes for the clients are

obtained

health service is equitable; given to most needy

health interventions are safe and are based on professional and

agency standards

good interpersonal relation, based on mutual respect

proper coordination among health workers and a working referral

system

efficiency and economy in the provision of services.

.Quality Assurance – Process of ensuring that clients
receive the agreed-upon level of care through setting
up of standards, monitoring and evaluation practices.

Example: The Sentrong Sigla Movement or Centers for

Vitality.

6.Standards - desired level of performance against actual

practice is compared. What should be ?

7. Advocacy and Political Action – An act of pleading for

or giving verbal support for a cause
- To speak up for the clients’ rights
- Speaking up and meeting with politicians
and hand in our issues, our positions,
demands and many.
- For policy making or legislations.
 Health : A “ state of complete physical, mental
and social well being and not merely the absence
of disease or infirmity” (WHO, 1946/1948)
: emphasis not the prevailing physical and
mental conditions of the people and the
community.
: recognizes the multifaceted nature of health
and that health involves different dimensions, it
considers the political, economic and
social/cultural dimensions that affect the living
conditions and quality of life
 2 Basic Components of a Concept of Health ( Kass)
1. well workingness - identifies the physical
ability of components of the body to function.
2. wholeness – simultaneous functioning of the
different components of the ability to self-heal.

Health : is the ability of the person to adapt to continuing

physical, social and personal change ( Dubos, Candus,
Thrall)

Health : a state in which the organism is “functioning

effectively, fulfilling needs, successfully responding to the
requirement or demands of the environment, whether
external or internal, and pursuing its biological destiny,
including growth and reproduction. ( Engel)
Disease – “that which is malfunctioning or maladaptation of
biologic of biologic and psychophysiologic processes in the
individual”
- may occur at any biological level i.e. the cell, the
organ, system, and the body.
- Incapacity to perform one’s roles.

Illness – “the threat of incapacity of the person to fulfill

personal expectations or perform social role or task”
refers more to the experiential/ behavioral level
nonphysical and nonphysiological incapacity
as personal, interpersonal and cultural responses to disease or
discomfort
Three Structural Domains of Health Care

1. Professional – utilizes biomedicine and which is

primarily interested in the recognition and
treatment of disease (curing) and generating
technological intervention.

2. Popular – family and social networks

3. Folk – non professional healers or the traditional

healing.

Both popular and folk or traditional healing are

principally concerned with illness that is treating
the human experience of disease.
CHN/PHN
Community Health Nursing
-one of the two major fields of Nursing in the
Philippines
- the other is Hospital Nursing

Definitions of CHN
By Ruth B. Freeman:
It refers to a “a service rendered by
professional nurse with communities, groups,
families, individuals at home, in health centers, in
clinics, in school, in places of work for the promotion
of health, prevention of illness, care of the sick at
home and rehabilitation.
By Jacobson
Is a learned practice discipline with ultimate goal
of contributing, as individuals and in collaboration
with others, to the promotion of the client’s optimum
level of functioning through teaching and delivery of
care.

By American Nurses Association

CHN practice promotes and preserves the health
of populations by integrating the skills and knowledge
relevant to both nursing and public health.
COMMUNITY HEALTH NURSING
- is broader than public health nursing because it
encompasses “nursing practice in a wide variety of community
services and consumer advocate areas, and in a variety of roles,
at times including independent practice.

- is the synthesis of nursing practice and public health

practice.

2 Major Fields of Nursing in the Philippines

1. Community Health Nursing

-School health nursing

-Occupational health nursing

2. Hospital Nursing or Institutional Nursing

PUBLIC HEALTH NURSING - (WHO) is a special
field of nursing that combines skills in public health
nursing, public health, and some phases of social
assistance and function as part of the total public
health program for the: promotion of health,
improvement of condition in social and physical
environment, rehabilitation, prevention of illness and
disability.
Public Health (By Dr. C.E. Winslow)
The Science and Art of :
(1) preventing disease,
(2) prolonging life, and
(3) promoting health and efficiency though organized
community effort for
a. the sanitation of the environment,
b. the control of communicable disease,
c. the education of individuals in personal hygiene,
d. the organization of medical and nursing services for the early
diagnosis preventive treatment of disease and
e. the development of social machinery to insure a standard of
living adequate for the maintenance of health, so organizing
there benefits as to enable every citizen to realize his birth right
of health and longevity.
Key phrase: “through community effort”
Ex: Government efforts (legislation,
support from taxes, etc.), private efforts or
funds, multidisciplinary public health efforts.

Mission of Public Health – SOCIAL JUSTICE

…….which entitles all persons to basic
necessities: adequate income and health
protection, accepts collective burdens to make
such possible.
COMMUNITY HEALTH NURSING

- its basic knowledge and skills are anchored on Nursing

Theories and Concepts from the science of the public
health such as:

1. Importance of the greatest good for the greater

number (ethics)

2. Assess health needs, plan, implement, and evaluate

the impact of health services on population or groups
(nursing process)

3. Priority of health promotion and disease prevention

strategies over curative
4. Tools for measuring and analyzing community health
problem
(Biostatistics, Demography, Epidemiology)

5. Application of principle of management and organization

6. Its practice and enhanced by bodies of knowledge of

other academic discipline (sociology, psychology,
anthropology, economics, political science)

Philosophy of CHN: Worth and Dignity of Man (Person)

By: Margaret Shetland.
 Highlight/ Concept of C H N

1. Goal of Professional Practice→ Promotion of health and Preservation

of life
2. Nature of Practice→ Comprehensive, general, continual, not episodic
3. Knowledge Base→ Nursing and Public Health
4. Levels of Clientele→ individual, families, groups (aggregate),
community, sick or well in daily basis, health tasks, children,
elderly, youth
5. Practitioner’s recognition→ Primacy of population as a whole
6. Greater control for both nurse and client in health care decision
7. Collaboration between nurse and clients as equals
8. Recognition of the impact of different factors of their client lives and
situation
Goal of CHN
“To raise the level of health of the citizenry”
► to help the community and families to cope until discontinuities
of health and threats; a way to maximize potential for high level wellness
and promote reciprocally supportive relationship between people and their
physical and social environment.
PRINCIPLES OF CHN
1.Based on recognized needs of communities, families, groups and
individual

2.Full understanding of objectives and policies of the agency

3.Family is the unit of services

4.Available to all regardless of sex, status, political beliefs and others.

5.Health teaching a primary responsibility of community health nurse.

6.The nurse works as a member of the team

7.Periodic evaluation of Community Health Nursing Services

8.Opportunities continuing education and professional growth

9.Make use of available community health resources

10.Utilizes existing active organized groups

11.Provide educative supervision

12.Accurate Recording and Reporting

SUB-SPECIALTIES OF CHN

1.Occupational Health Nursing

• health care services for workers and worker population

• promotion, protection and restoration of worker’s health in the context

of a safe and healthy work environment.

• aim: to cope with actual and potential stresses for optimum level of
physical and psychological functioning

• determined by: Government Policies and Standards (DOLE, DOH,

SSS, Phil. Health) are Professional Standards (OHNAP, PNA).
2.School Health Nursing

 to promote health of school children and prevent

health problem that hinders learning and
performance of their developmental task.

Health on important requisite in education

determined by: age, developmental stage, health

problems, genetic consideration; policies and
standards of DECS/DepEd, DOH, and the nursing
professions; socio-economic realities in the schools
and LGU’s.
Clients of the Community Health Nurse
1.Individual

- sick or well
- on a daily basis
- who consult at the health center and receives services

a. prenatal
b. well-baby follow up
c. morbidity
d. chronic illness: diabetes, hypertension
e. clients seen during home follow up
f. school consultation
g. workplace visit- conference
h. other community based activities
2. Family

Rationale: (Maglaya & Bailon)

1.Natural and fundamental unit of society; important social
institution

2.Generates, prevents, tolerates and connect healthy problems

within its members

3.Health problems of family members are interlocking

4.The most frequent focus of health decisions and actions in

personal care.

5.An effective and available channel for much of the community

nursing effort.

6.Service of the most solid support to its members specially the

young, elderly and less-fortunate.
Family Health Nursing

- A level of community nursing practices directed on the family as the unit of

care, with the Health as the Goal and Nursing as the medium, Channel or
Provider of Care
Nurses Role and Functions: assist family cope effectively with health problem
by increasing in capacity to perform with health task and to render family
independent with continues guidance of the nurse till no longer needed.

Roles of the Nurse:

1.Health Monitor

2.Provider of Care

3.Coordinator of family service

4.Facilitator

5.Teacher

6.Counselor
Family Case Load

- number and kind of families a nurse handles at any given time

(prioritizing on problematic families: low income/ poor, with illness,
pregnant, children, elderly)

Family Health Tasks

-are basis for effective coping and family nursing problem statement

3. Population Group or Aggregate

- who share common characteristics, developmental stage, common

exposure to environmental factor which results to common health to to
to common health problems

a. children e. prisoners
b. women f. farmers
c. factory worker g. elderly
d. commercial sex workers
Leading ailments of school children

a. dental carries g. otitis media

b. parasitism h. tinea flava
c. colds i. PEM
d. Pediculosis j. EOR & Blindness
e. URTI k. enlarged glands
f. CEDC- Children in Especially
Difficult Circumstances
Ex: neglected, street children, impaired with disability,
drug users, working children, cultural minorities & IPs
Elderly/Senior Citizen – 4.5 million

a. influenza g. COPD
b.T.B. h. ischemic heart disease
c. Bronchitis i. Respiratory Disease
d. Pneumonia j. Asthma
e. CVD k. Physical disabilities
f. Senility
Women- Nearly 60% of the Phil. population

1. Domestic violence & VAW

2. Uncontrolled Pregnancies & Abortion
3. Contraceptives Use & FP
4. Anemia
5. Etc….

4. Community

@ A group of people sharing a common geographic boundaries and/ or

common values and interest. It functions within a particular
sociocultural context with varying physical environment, coping and
behaving. (Maglaya 2003, Nsg. Practice in Community)

@ A social group of people interacting with each other, determined by

geographic boundaries, living together to attain certain and common
goals and sharing the same interests (Untalan 2005, COPAR)
@ Refers to groups composed of individuals, families, organizations,
or business that share a common language, common values, a
common history, or common purpose. ( Aleria Narda 2003,
Community Health and Wellness Needs Asst.)

@ Communities= Fellowship

B. Characteristics (Maglaya)

1.Defined by its geographic boundaries with certain identifiable

characteristics. Ex.

2.Urban Poor Communities, Indigenous People, Peasant, etc…

3.Made up of institutions organized into social systems linked in a

complex network having formal, informal power structure and
communication system.
4.Common or shared interest that binds together

5.Has area with fluid boundaries which a problem can be identified

and solved.

6.Has a population aggregate concept.

“Aggregate”- people may or may not belong to a certain

community but together to achieve one goal.

-who share some common aspect, such as age,

economic status, cultural background, gender, races, area of
residence, chronic illness, etc. (Swanson & Albert)
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