COMMUNITY HEALTH NURSING

1 Safe and Quality Care Health Education Communication Collaboration and

Teamwork
1.1 Principles and Standards o CHN
Basic Principles of CHN
1. The community is the patient in CHN, the family is the unit of care and there are four
levels of clientele: individual, family, population group (those ho share common
characteristics, developmental stages and common e!posure to health pro"lems #
e.g. children, elderly$ and the community.
%. &n CHN, the client is considered as an 'CT&() partner N*T P'++&() recipient of
care.
,. CHN practice is affected "y developments in health technology, in particular,
changes in society, in general
-. The goal of CHN is achieved through multi.sectoral efforts
/. CHN is part of heath care system and the larger human service system.
1.! Le"els o Care
1. Primary 0evel of Care # is devolved to the cities and the municipalities. &t is
health care provided "y center physicians, pu"lic health nurses, rural health
midives, "arangay health or1ers, traditional healers and others at the
"arangay health stations and rural health units. The primary health facility is
usually the first contact "eteen the community mem"ers and the other
levels of health facility.
%. +econdary 0evel of Care
+econdary care is given "y physicians ith "asic health training. This is
usually given in health facilities and district hospitals and out.patient
departments of provincial hospitals. This serves as a referral center for the
primary health facilities. +econdary facilities are capa"le of performing minor
surgeries and perform some simple la"oratory e!aminations.
,. Tertiary 0evel of Care # is rendered "y specialists in health facilities including
medical centers as ell as regional and provincial hospitals, and speciali2ed
hospitals such as the Philippine Heart Center. The tertiary health facility is the
referral center for the secondary care facilities. Complicated cases and
intensive care re3uires tertiary care and all these can "e provided "y the
tertiary care facility.
1.# T$pes o Clientele
&ndividual
Basic approaches in loo1ing at the individual:
1. 'tomistic
%. Holistic
Perspectives in 4nderstanding the individual:
1. Biological
a. 4nified hole
". Holon
c. 5imorphism
%. 'nthropological
a. essentialism
". +ocial constructionism
c. Culture
,. Psychological
a. Psychose!ual
". Psychosocial
c. Behaviorism
d. +ocial learning
-. +ociological
a. 6amily and 1inship
". +ocial groups
6amily
7odels:
-. 5evelopmental
+tages of 6amily 5evelopment
+tage 1 # The Beginning 6amily
+tage % # The )arly Child."earing 6amily
+tage , # The 6amily ith Preschool Children
+tage - # The 6amily ith +chool 'ge Children
+tage / # The 6amily ith Teenagers
+tage 8 # The 6amily 's 0aunching Center
+tage 9 # The 7iddle.aged 6amily
+tage : # The 'ging 6amily
/. +tructural.6unctional
&nitial 5ata Base
6amily structure and Characteristics
+ocio.economic and Cultural 6actors
)nvironmental 6actors
Health 'ssessment of )ach 7em"er
(alue Placed on Prevention of 5isease
6irst 0evel 'ssessment
Health Threats:
Conditions that are conducive to disease, accident or failure to
reali2e one;s health potential
Health deficits:
&nstances of failure in health maintenance (disease, disa"ility,
developmental lag$
+tress points<6orseea"le crisis situation:
'nticipated periods of unusual demand on the individual or family in
terms of ad=ustment or family resources
+econd 0evel 'ssessment:
>ecognition of the pro"lem
5ecision on appropriate health action
Care to affected family mem"er
Provision of health home environment
4tili2ation of community resources for health care
Pro"lem prioriti2ation:
Nature of the pro"lem
Health deficit
Health threat
6orseea"le Crisis
Preventive Potential
High
7oderate
0o
7odifia"ility
)asily modifia"le
Partially modifia"le
Not modifia"le
+alience
High
7oderate
0o
6amily +ervice and Progress >ecord
Population ?roup
(ulnera"le ?roups:
&nfants and @oung Children
+chool age
'dolescents
7others
7ales
*ld People
+peciali2ed 6ields:
Community 7ental Health Nursing # a uni3ue process hich includes an
integration of concepts from nursing, mental health, social psychology,
psychology, community netor1s, and the "asic sciences
*ccupational Health Nursing # the application of nursing principles and
procedures in conserving the health of or1ers in all occupations
+chool Health Nursing # the application of nursing theories and principles in
the care of the school population
1.% Healt& Care 'eli"er$ S$ste(
The Philippine health care delivery system is composed of to sectors: (1$ the pu"lic sector,
hich largely financed through a ta!."ased "udgeting system at "oth national and local
levels and here health care is generally given free at the point of service and (%$ the
private sector (for profit and non.profit providers$ hich is largely mar1et.oriented and here
health care is paid through user fees at the point of service.
The pu"lic sector consists of the national and local government agencies providing health
services. 't the national level, the 5epartment of Health (5*H$ is mandated as the lead
agency in health. &t has a regional field office in every region and maintains specialty
hospitals, regional hospitals and medical centers. &t also maintains provincial health teams
made up of 5*H representatives to the local health "oards and personnel involved in
communica"le disease control, specifically for malaria and schistosomiasis. *ther national
government agencies providing health care services such as the Philippine ?eneral Hospital
are also part of this sector.
Aith the devolution of health services, the local health system is no run "y 0ocal
?overnment 4nits (0?4s$. The provincial and district hospitals are under the provincial
government hile the city<municipal government manages the health centers<rural health
units (>H4s$ and "arangay health stations (BH+s$. &n every province, city or municipality,
there is a local health "oard chaired "y the local chief e!ecutive. &ts function is mainly to
serve as advisory "ody to the local e!ecutive and the sanggunian or local legislative council
on health.related matters.
The private sector includes for.profit and non.profit health providers. Their involvement in
maintaining the people;s health is enormous. This includes providing health services in
clinics and hospitals, health insurance, manufacture of medicines, vaccines, medical
supplies, e3uipment, and other health and nutrition products, research and development,
human resource development and other health.related services.

1.) Pri(ar$ Healt& Care
AH* defines PHC as essential health care made universally accessi"le to individuals and
families in the community "y means accepta"le to them through their full participation and at
a cost that the community and country can afford at every stage of development.
Primary Health Care as declared during the 6irst &nternational Conference on Primary
Health Care held in 'lma 'ta, 4++> on +eptem"er 8.1%, 1B9: "y AH*. The goal as
CHealth for 'll "y year %DDD.E This as adopted in the Philippines through 0etter of
&nstruction B-B signed "y President 7arcos on *cto"er 1B, 1B9B and has an underlying
theme of CHealth in the Hands of the People "y %D%D.E
)lements<Components of Primary Health Care
1. )nvironmental +anitation (ade3uate supply of safe ater and good aste disposal$
%. Control of Communica"le 5iseases
,. &mmuni2ation
-. Health )ducation
/. 7aternal and Child Health and 6amily Planning
8. 'de3uate 6ood and Proper Nutrition
9. Provision of 7edical Care and )mergency Treatment
:. Treatment of 0ocally )ndemic 5iseases
B. Provision of )ssential 5rugs
The frameor1 for meeting the goal of primary health care is organi2ational strategy, hich
calls for active and continuing partnership among the communities.
6our Cornerstones<Pillars in Primary Health Care
1. 'ctive community participation
%. &ntra and inter.sectoral lin1ages
,. 4se of appropriate technology
-. +upport mechanism made availa"le
Types of Primary Health Care Aor1ers
(arious categories of health or1ers ma1e up the primary health care team. The types
vary in different communities depending upon:
'vaila"le health manpoer resources
0ocal health needs and pro"lems
Political and financial feasi"ility
To levels of primary health care or1ers have "een identified:
(illage or Barangay Health Aor1ers ((<BHAs$. This refers to trained community
health or1ers or health au!iliary volunteer or a traditional "irth attendant or
healer
&ntermediate level health or1ers. ?eneral medical practitioners or their
assistants. Pu"lic Health Nurse, >ural +anitary &nspectors and 7idives may
compose these groups.
1.6 *a(il$ +ased N,rsin- Ser"ices .*a(il$ Healt& N,rsin- Process/
Nursing 'ssessment of 6amily:
6irst 0evel 'ssessment:
1. 6amily structure, characteristics and dynamics
%. +ocio.economic and cultural characteristics
,. Home and environment
-. Health status of each mem"er
/. (alues and practices on health promotion<maintenance and disease
prevention
+econd 0evel 'ssessment data include those that specify or descri"e the family;s
realities, perceptions a"out and attitudes related to the assumption or
performance of family health tas1s on each health condition or pro"lem identified
during the first level assessment.
5eveloping the Nursing Care Plan
+teps in developing a family care plan:
1. The prioriti2ed condition<s or pro"lems
%. The goals and o"=ectives of nursing care
,. The plan of interventions
-. The plan for evaluating care
&mplementing the Nursing Care Plan
5uring this phase the nurse encounters the realities in family nursing practice
hich can motivate her to try out creative innovations or overhelm her to
frustration or inaction. 's the nurse practitioner or1s ith clients she
e!periences varying degrees of demands on her resources. ' dynamic attitude
on personal and professional development is, therefore, necessary if she has to
face up to challenges of nursing practice.
)valuation of 6amily Health +ervices
1.0 Pop,lation Gro,p +ased N,rsin- Ser"ices
1.1 Co((,nit$ +ased N,rsin- Ser"ices
'ssessment of Community Health Needs
Community 5iagnosis aims to o"tain a general information a"out the community.
The folloing are elements of a comprehensive community diagnosis:
a. 5emographic (aria"les
". +ocio.)conomic and Cultural (aria"les
c. Health and &llness Patterns
d. Health >esources
e. Political<0eadership Patterns
+teps in Conducting Community 5iagnosis
a. 5etermining the *"=ectives
". 5efining the +tudy Population
c. 5etermining the 5ata to "e Collected
d. Collecting the 5ata
e. 5eveloping the &nstrument
f. 'ctual 5ata ?athering
g. 5ata Collation
h. 5ata Presentation
i. 5ata 'nalysis
=. &dentifying the Community Health Nursing Pro"lems
1. Priority.setting
Planning for Community Health Nursing Programs and +ervices
?oal and *"=ective +etting
Nursing &ntervention for Community Health 5evelopment
Community *rgani2ing
)valuation of Community Health Nursing
1.2 Co((,nit$ Or-ani3in-
+tudies have underscored some 1ey elements of the community hich may "e reactivated
to "ring social and "ehavioral change. These include social organi2ations (relationships,
structure and resources$, ideology (1noledge, "eliefs and attitudes$ and change agents.
This process of change is often termed as CempoermentE or "uilding the capa"ility of
people for future community action.
6ive stages of *rgani2ing: ' Community Health Promotion 7odel
+tage 1: Community 'nalysis
CThe process of assessing and defining needs, opportunities and resources involved in
initiating community health action program. This process may "e referred to as Ccommunity
diagnosis,E Ccommunity needs assessment,E Chealth education planning,E and Cmapping.E
This analysis has five components:
1. ' demographic, social and economic profile of the community derived from
secondary data.
%. Health ris1 profile (social, "ehavioral and environmental ris1s$. Behavioral ris1
assessment includes dietary ha"it and other lifestyle concerns li1e alcohol, to"acco,
and drugs. +ocial indicators of ris1 are studies "ecause of its associations to health
status and this may include e!posure to long.term unemployment, lo education and
isolation.
,. Health<ellness outcomes profile (mor"idity<mortality data$
-. +urvey of current health promotion programs
/. +tudies conducted in certain target groups
+teps in community analysis:
1. 5efine the Community. 5etermine the geographic "oundaries of the target
community. This is usually done in consultation ith representatives of the various
sectors.
%. Collect data. 's earlier mentioned, several types of data have to "e collected and
analy2ed.
,. 'ssess community capacity. This entails an evaluation of the Cdriving forcesE hich
may facilitate or impede the advocated change. Current programs have to "e
assessed including the potential of the various types of leaders<influential,
organi2ation and programs.
-. 'ssess community "arriers. 're there features of the ne program hich run counter
to e!isting customs and traditionsF &s the community resilient to changeF
/. 'ssess readiness for change. 5ata gathered ill help in the assessment of
community interest, their perception on the importance of the pro"lem.
8. +ynthesis data and set priorities. This ill provide a community profile of the needs
and resources, and ill "ecome the "asis for designing prospective community
interventions for health promotion.
+tep %: 5esign and &nitiation
&n designing and initiating interventions the folloing should "e done:
1. )sta"lish a core planning group and select a local organi2er. 6ive to eight committed
mem"ers of the community may "e selected to do the planning and management of
the program.
%. Choose an organi2ational structure. There are several organi2ation structures hich
can "e utili2ed to activate community participation. These include the folloing:
0eadership "oard or council # e!isting local leaders or1ing for a common
cause
Coalition # lin1ing organi2ations and groups to or1 on community issues.
C0eadE or official agency # a single agency ta1es the primary responsi"ility of
a liaison for health promotion activities in the community.
?rass.roots # informal structures in the community li1e the neigh"orhood
residents.
Citi2en panels # a group of citi2ens (/.1D$ emerge to form a partnership ith
a government agency
Netor1s and consortia # Netor1 develop "ecause of certain concerns.
,. &dentify, select and recruit organi2ational mem"ers. 's much as possi"le, different
groups, organi2ations sectors should "e represented. Chosen representative have
poer for the groups they represent.
-. 5efine the organi2ation mission and goals. This ill specify the hat, ho, here,
hen and e!tent of the organi2ational o"=ectives.
/. Clarify roles and responsi"ilities of people involved in the organi2ation. This is done
to esta"lish a smooth or1ing relationship and avoid overlapping of responsi"ilities.
8. Provide training and recognition. 'ctive involvement in planning and management of
programs may re3uire s1ills development training. >ecognition of the program;s
accomplishment and individual;s contri"ution to the success of the program and
"oost morale of the mem"ers.
+tage ,: &mplementation
&mplementation put design phase into action. To do so, the folloing must "e done:
1. ?enerate "road citi2en participation. There are several ays to generate citi2en
participation. *ne of them is organi2ing tas1 force, ho, ith appropriate guidance
can provide the necessary support.
%. 5evelop a se3uential or1 plan. 'ctivities should "e planned se3uentially.
*ftentimes, plan has to "e modified as events unfold. Community mem"ers may
have to constantly monitor implementation steps.
,. 4se comprehensive, integrated strategies. ?enerally the program utili2e more than
one strategies that must complement each other.
-. &ntegrate community values into the programs, materials and messages. The
community language, values and norms have to "e incorporated into the program.
+tage -: Program 7aintenance # Consolidation
The program at this point has e!perienced some degree of success and has eathered
through implementation pro"lems. The organi2ation and program is gaining acceptance in
the community.
To maintain and consolidate gains of the program, the folloing are essential:
1. &ntegrate intervention activities into community netor1s. This can "e affected through
implementation pro"lems. The organi2ation and program is gaining acceptance in the
community.
%. )sta"lish a positive organi2ational culture. ' positive environment is a critical element in
maintaining cooperation and preventing fast turnover of mem"ers. This is the result of
good group "ased on trust, respect, and openness.
,. )sta"lish an ongoing recruitment plan. &t should "e e!pected that volunteers may leave
the organi2ation. This re3uires a "uilt in mechanism for continuous recruitment and
training of ne mem"ers.
-. 5isseminate results. Continuous feed"ac1 to the community on results of activities
enhances visi"ility and acceptance of the organi2ation. 5issemination of information is
vital to gain and maintain community support.
+tage /: 5issemination. >eassessment
Continuous assessment is part of the monitoring aspect in the management of the program.
6ormative evaluation is done to provide timely modification of strategies and activities.
Hoever, "efore any programs reach its final step, evaluation is done for future direction.
1. 4pdate the community analysis. &s there a change in leadership, resources and
participationF This may necessitate reorgani2ation and ne colla"oration ith other
organi2ations.
%. 'ssess effectiveness of interventions<programs. Guantitative and 3ualitative methods of
evaluation can "e used to determine participation, support and "ehavior change level of
decision.ma1ing and other factors deemed important to the program
,. Chart future directories and modifications. This may mean revision of goals and
o"=ectives and development of ne strategies. >evitali2ation of colla"oration and
netor1ing may "e vital in support of ne ventures.
4. +ummari2e and disseminate results. +ome organi2ations die "ecause of the lac1 of
visi"ility. Thus, a dissemination plan may"e helpful in diffusion of information to further
"oost support to the organi2ation;s endeavor.
1.14 P,5lic Healt& Pro-ra(s
6'7&0@ H)'0TH
The 7aternal Health Program
a. 'ntenatal >egistration
". Tetanus To!oid &mmuni2ation
c. 7icronutrient +upplementation
d. Treatment of 5iseases and *ther Conditions
e. Clean and +afe 5elivery
The 6amily Planning Program
The family planning methods:
1. 6emale +terili2ation
%. 7ale +terili2ation
,. Pill
-. 7ale condom
/. &n=ecta"les
8. 0actating 'menorrhea 7ethods or 0'7
9. 7ucus<Billings<*vulation
:. Basal Body Temperature
B. +ymptothermal method
1D. To 5ay 7ethod
11. +tandard 5ays 7ethod
The Child Health Programs (Ne"orns, &nfants and Children$
Ne"orns, infants and children are vulnera"le age group for common
childhood diseases. The ris1 of infection among children is higher hen not
screened for meta"olic disorder, not e!clusively "reastfed, unvaccinated, not
properly managed hen sic1, not given ith vitamin supplementation and many
others. To address pro"lems, child health programs have "een created and
availa"le in all health facilities hich includes:
&nfants and @oung Child 6eeding
Ne"orn +creening
)!panded Program on &mmuni2ation
6accine Mini(,(
A-e at 1
st
dose
N,(5er
o doses
Mini(,(
inter"al
5et7een doses
Reason
BC? Birth or
anytime after
"irth
1 BC? given at earliest
possi"le age protects the
possi"ility of TB
meningitis and other TB
infections in hich infants
are prone,
5PT 8 ee1s , - ee1s 'n early start ith 5PT
reduces the chance of
severe pertussis.
*P( 8 ee1s , - ee1s The e!tent of protection
against polio is increased
the earlier the *P( is
given Heeps the
Philippine polio free
Hepatitis
B
't "irth , 8 ee1s interval
from 1
st
dose to
%
nd
dose and :
ee1s interval
from %
nd
dose to
third dose
'n early start of Hep B
reduces the chance of
"eing infected and
"ecoming a carrier.
Prevent liver cirrhosis and
liver cancer. '"out BDDD
die of complications of
HB. 1DI of 6ilipinos have
chronic HB infection.
)liminate HB "efore %D1%
(a Aestern >egional
goal$.
'dministration of (accines
6accine 'ose Ro,te o
Ad(inistration
Site o
Ad(inistration
BC? &nfants D.D/ ml &ntradermal >ight deltoid region of
the arm
5PT D./ ml &ntramuscular 4pper outer portion of
the thigh
*P( % drops or
depending on
manufacturer;s
instructions
*ral mouth
7easles D./ ml +u"cutaneous *uter part of the
upper arm
Hepatitis B D./ ml &ntramuscular 4pper outer portion of
the thigh
Tetanus
To!oid
D./ ml &ntramuscular 5eltoid region of the
upper arm
7anagement of Childhood &llnesses
7icronutrient +upplementation
5ental health )arly Child 5evelopment
Child Health &n=uries
&ts main goal is to reduce mor"idity and mortality rates for children D.B years ith the
strategies necessary for program implementation.
)ssential Pac1ages of Health +ervices for Ne"orn, &nfant and Child
The 'dolescent Health Program
The 'dult 7en Health Program
The 'dult Aomen Health Program
The *lder Person Health Program
Philippine >eproductive Health
N*N.C*774N&C'B0) 5&+)'+) P>)()NT&*N 'N5 C*NT>*0
&. &ntegrated Community Based Non.Communica"le 5isease Prevention and Control
Program
&&. Causes and >is1 6actors of 7a=or NC5s
'. 5iseases of the Heart and Blood (essels
1. Hypertension
%. Coronary 'rtery 5isease
,. Cere"rovascular 5isease or +tro1e
B. Cancer
C. 5ia"etes 7ellitus
5. Chronic *"structive Pulmonary 5isease
). Bronchial 'sthma
&&&. >is1 'ssessment and +creening Procedures
>is1 6actor 'ssessment:
'. Cigarette +mo1ing
B. Nutrition<5iet
C. *vereight<*"esity
5. Physical &nactivity<+edentary 0ifestyle
). )!cessive 'lcohol 5rin1ing
+creening ?uidelines and Procedures:
'. +creening for Hypertension
B. +creening for )levated Cholesterol in the Blood
C. +creening for 5ia"etes 7ellitus
5. +creening for Cancer
). +creening for C*P5
6. +creening for 'sthma
&(. Promoting Physical 'ctivity and )!ercise
(. Promoting Proper Nutrition
(&. Promoting a +mo1e.6ree )nvironment
(&&. Promoting +tress 7anagement
(&&&. Programs for the Prevention and Control of other non.communica"le diseases
'. National Prevention of Blindness Program
B. 7ental Health and 7ental 5isorders
C. >enal 5isease Control Program
5. Community."ased >eha"ilitation Program
C*774N&C'B0) 5&+)'+) P>)()NT&*N 'N5 C*NT>*0
Tu"erculosis
0eprosy
+chistosomiasis
6ilariasis
7alaria
5engue Hemorrhagic 6ever (H.6ever$
7easles
Chic1en Po! ((aricella$
7umps ()pidemic Parotitis$
5iptheria
Ahooping Cough (Pertussis$
Tetanus Neonatorum and Tetanus among older age groups
&nfluen2a
Pneumonias
Cholera ()l Tor$
Typhoid 6ever
Bacillary 5ysentery (+higellosis$
+oil Transmitted Helminthiases
Paragonimiasis
Hepatitis '
Paralytic +hellfish Poisoning (P+P & >)5 T&5) P*&+*N&N?$
0eptospirosis
>a"ies
+ca"ies
'nthra!
+e!ually Transmitted &nfections
i. ?onorrhea
ii. +yphilis
iii. Chlamydia
iv. ?ardianella (aginitis
v. Trichomoniasis
vi. Hepatitis B
H&(<'&5+
7eningococcemia
CBird 6luE or 'vian influen2a
+'>+ # +evere 'cute >espiratory +yndrome
2 Research and Quality Improement
!.1 Researc& in t&e Co((,nit$
>esearch is an important activity in pu"lic health "ut it is misconceived to "e primarily an
activity of professional researchers and academicians. 'lthough it is not commonly included
in the PHN;s statement of duties and responsi"ilities, research is nonetheless included in the
scope of functions of the nurse as defined "y the Nursing 0a.
>esearch in community health serves a num"er of purposes, among hich are: (1$ improve
our understanding of clients and their specific conte!tsJ (%$ provide data needed for program
and policy development and evaluationJ (,$ improve the delivery of health services and
implementation of e!isting programsJ (-$ improve cost.effectiveness of programsJ and (/$
pro=ect a good image of nurses.
The PHN can initiate CsmallE researches on the ma=or concerns in health service delivery
and in the management of the health facility. >esearch topics that could "e studied "y the
PHN "y himself<herself include, among others, sociodemographic profile of those ho utili2e
health services, client aiting time, referral from and to the health center, perception of
clients on the delivery of health services, response of clients to different health or nursing
interventions, supply management and effects of specific health education activities.
>esearch also contri"utes to hat is called evidence."ased practice. The practices that
ere passed on and ere considered as gospel truth in the past should "e e!amined and
tested through research. The challenge, not only PHNs "ut to ma=or decision ma1ers in the
local health system is to integrate research into the management and operation of the health
facility.

!.! National Healt& Sit,ation
Health &ndices
&. Basic Health &ndicators
'. Nutrition
B. 5isease Patterns
0eading Causes of 7or"idity
0eading Causes of 7ortality
&&. *ther &ndicators
'. &nfant 7ortality >ate
B. 7aternal 7ortality >ate
C. 0ife )!pectancy at Birth
5. 7edian 'ge
). Crude >ates
1. Crude "irth rate
%. Crude death rate
Health Care 5elivery +ystem . the totality of all policies, e3uipments, products, human
resources and services hich address the health needs, pro"lems and concerns of the
people. &t is large, comple!, multi.level and multi.disciplinary.
Categories:
Accordin- to Increasin-
Co(ple8it$ o t&e Ser"ices
Pro"ided
Accordin- to t&e T$pe o Ser"ice
Type +ervice Type +ervice
Primary Health Promotion,
Preventive Care,
Continuing Care for
common health
pro"lems, attention to
psychological and
social care, referrals
Health
Promotion and
illness
prevention
&nformation
5issemination
+econdary +urgery, 7edical
services "y specialists
5iagnosis and
Treatment
+creening
Tertiary 'dvanced,
speciali2ed,
diagnostic,
therapeutic and
reha"ilitative care
>eha"ilitation PT<*T
The Health +ector
.5epartment of Health
(ision: Health for all "y year %DDD and Health in the Hands of the People "y %D%D
7ission: &n partnership ith the people, provide e3uity, 3uality and access to
health care especially the marginali2ed
/ 7a=or 6unctions:
1. )nsure e3ual access to "asic health services
%. )nsure formulation of national policies for proper division of la"or and proper
coordination of operations among the government agency =urisdictions
,. )nsure a minimum level of implementation nationide of services regarded as
pu"lic health goods
-. Plan and esta"lish arrangements for the pu"lic health systems to achieve
economies of scale
/. 7aintain a medium of regulations and standards to protect consumers and
guide providers
.0ocal ?overnment 4nits
.Private +ector
.Composed of "oth commercial and "usiness organi2ations, non."usiness
organi2ations
N?*s # assumes the folloing roles:
Policy and 0egislative 'dvocates
*rgani2ers, Human >ights 'dvocates
>esearch and 5ocumentation
Health >esource 5evelopment Personnel
>elief and 5isaster 7anagement
Netor1ing
!.# 6ital Statistics
+tatistics refers to a systematic approach of o"taining, organi2ing and analy2ing
numerical facts so that conclusion may "e dran from them.
(ital statistics refers to the systematic study of vital events such as "irths, illnesses,
marriages, divorce, separation and deaths.
+tatistics of disease (mor"idity$ and death (mortality$ indicate the state of health of a
community and the success or failure of health or1.
4se of (ital +tatistics:
&ndices of the health and illness status of a community
+erves as "ases for planning, implementing, monitoring and evaluating
community health nursing programs and services
+ources of 5ata:
Population census
>egistration of (ital 5ata
Health +urvey
+tudies and researches
>ates and >atios:
>ate # shos the relationship "eteen a vital event and those persons e!posed to the
occurrence of said event, ithin a given area and during a specified unit of time,
it is evident that the person e!periencing the event (Numerator$ must come from
the total population e!posed to the ris1 of same event (5enominator$.
Commercial<Business Non.commercial
Profit.oriented *rientation to social development, relief and
reha"ilitation, community organi2ing
7anufacturing companies
'dvertising agencies
Private practitioners
Private institutions
+ocio.civic groups
>eligious organi2ations<foundations
>atio # is used to descri"e the relationship "eteen to (%$ numerical 3uantities or
measures of events ithout ta1ing particular considerations to the time or place.
These 3uantities need not necessarily represent the same entities, although the
unit of measure must "e the same for "oth numerator and denominator of the
ratio.
Crude or ?eneral >ates # referred to the total living population. &t must "e presumed that
the total population as e!posed to the ris1 of the occurrence
of the event.
+pecified >ate # the relationship is for a specific population class or group. &t limits the
occurrence of the event to the portion of the population definitely
e!posed to it.
Crude Birth >ate # a measure of one characteristic of the natural groth or increase of a
population.
Crude 5eath >ate # a measure of one mortality from all causes hich may result in a
decrease of population.
&nfant 7ortality >ate # measures the ris1 of dying during the 1
st
year of li1e. &t is a good
inde! of the general health condition of a community since it
reflects the changes in environment and medical condition of a
community.
7aternal 7ortality >ate # measures the ris1 of dying from causes related to pregnancy,
child"irth, and puerperium. &t is an inde! of the o"stetrical care
needed and received "y omen in a community.
6etal 5eath >ate # measures pregnancy astage. 5eath of the product of conception
occurs prior to its complete e!pulsion, irrespective of duration of
pregnancy.
Neonatal 5eath >ate # measures the ris1 of dying the 1
st
month of life. &t serves as an
inde! of the effects of prenatal care and o"stetrical management
of the ne"orn.
+pecific 5eath >ate # descri"es more accurately the ris1 of e!posure of certain classes
of groups to particular diseases. To understand the forces of
mortality, the rates should "e made specific provided the data are
availa"le for "oth the population and the event in their
specifications. +pecific rates render more compara"le and thus
reveal the pro"lem of pu"lic health.
&ncidence >ate # measures the fre3uency of occurrence of the phenomenon during a
given period of time.
Prevalence >ate # measures the proportion of the population hich e!hi"its a particular
disease at a particular time. This can only "e determined folloing a
survey of the population concerned, deals ith total (ne and old$
num"er of cases.
Proportionate 7ortality (5eath >atios$ # shos the numerical relationship "eteen
deaths from all causes (or group of causes$,
age (or group of age$ etc. and the total no. of
deaths from all causes in all ages ta1en
together.
'd=usted or +tandardi2ed >ate # to render the rates of % communities compara"le,
ad=ustment for the differences in age, se!, and any
other factors hich influence vital events have to "e
made.
7ethods:
By applying o"served specific rates to some standard population
By applying specific rates of standard population to corresponding classes or
groups of the local population
Case 6atality >atio # inde! of a 1illing poer of a disease and is influenced "y
incomplete reporting and poor mor"idity data.
Presentation of 5ata
The folloing are most commonly used graphs in presenting data:
0ine or curved graphs # shos pea1s, valleys and seasonal trends. 'lso used to
sho the trends of "irth and death rates over a period of time
Bar graphs # each "ar represents or e!presses a 3uantity in terms of rates or
percentages of a particular o"servation li1e causes of illness and deaths.
'rea diagram # (Pie Charts$ . shos the relative importance of parts of the hole.
6unctions of the Nurse:
Collects data
Ta"ulates data
'naly2es and interprets data
)valuates data
>ecommends redirection and<or strengthening of specific areas of health
programs as needed.
!.% Epide(iolo-$
&t is the study of occurrences and distri"ution of diseases as ell as the distri"ution and
determinants of health states or events in specified population, and the application of
this study to the control of health pro"lems. This emphasi2es that epidemiologist are
concerned not only ith deaths, illness and disa"ility, "ut also ith more positive health
states and ith the means to improve health.
)pidemiology is the "ac1"one of the prevention of diseases.
4ses of )pidemiology:
'ccording to 7orris, epidemiology is used to:
+tudy the history of the health population and the rise and fall of diseases and
changes in their character.
5iagnose the health of the community and the condition of people to measure
the distri"ution and dimension of illness in terms of incidence, prevalence,
disa"ility and mortality, to set health pro"lems in perspective and to define their
relative importance and to identify groups needing special attention.
+tudy the or1 of health services ith a vie of improving them. *perational
research shos ho community e!pectations can result in the actual provisions
of service.
)stimate the ris1 of disease, accident, defects and the chances of avoiding them.
&dentify syndromes "y descri"ing the distri"ution and association of clinical
phenomena in the population.
Complete the clinical picture of chronic disease and descri"e their natural history
+earch for causes of health and disease "y comparing the e!perience of groups
that are clearly defined "y their composition, inheritance, e!perience, "ehavior,
and environments.
The )pidemiologic Triangle consists of three component # host, environment and agent.
The model implies that each must "e analy2ed and understood for comprehensions and
prediction of patterns of a disease. ' change in any of the component ill alter an
e!isting e3uili"rium to increase or decrease the fre3uency of the disease.
!.) 'e(o-rap&$
5)7*?>'PH@ is the science hich deals ith the study of the human population si2e,
composition and distri"ution in space. Population si2e simply refers to the num"er of
people in a given place or area at a given time. Ahen the population is characteri2ed in
relation to certain varia"les such as age, se!, occupation or educational level, then the
population composition is "eing descri"ed. The nurse also descri"es ho people are
distri"uted in a specific geographic location.
5emographic information can "e o"tained from a variety of sources "ut the most
common come from censuses, sample surveys and registration systems.
The Philippines is one of the most populous countries in the orld. The total population
of the Philippines as of the latest census (%DDD$ conducted "y the National +tatistics
*ffice is at 98./ million persons ith an average annual groth rate of %.,8I. The
population is e!pected to dou"le "y the year %D,D.
The total num"er of 6ilipino households is 1/., million ith an average household si2e of
/.D persons. +lightly more than half of the Philippine population (/8I$ resides in 0u2on
here the metropolitan areas are. The National Capital >egion is li1eise the most
densely populated region ith 1/,819 persons occupying a s3. 1m. of land. Nearly - out
of 1D persons in the country reside in the National Capital >egion or in the ad=oining
regions of Central 0u2on and +outhern Tagalog.
Southern Tagalog Region registered the highest population with
11,793,655. The NCR is the most densely populated region with
15,617 persons per s. !m. o" land. This ratio is 61 times the
national #gure o" $55 persons per s. !m. C%R re&orded the
lowest population density with 95 persons per s. !m.
Population and Population Density
per Square Kilometer, by Region, 2000
Area Population Density
'hilippines 76,(9),735 $55
NCR 9,93$,56* 15,617
C%R 1,365,$$* 95
+lo&os Region ,Region +- (,$**,(7) 3$7
Cagayan .alley ,Region $- $,)13,159 1*5
Central /u0on ,Region 3- ),*3*,9(5 ((1
Southern Tagalog ,Region (- 11,793,655 $51
1i&ol Region ,Region 5- (,67(,)55 $65
2estern .isayas ,Region 6- 6,$*),733 3*7
Central .isayas ,Region 7- 5,7*1,*6( 3)1
3astern .isayas ,Region )- 3,61*,355 173
2estern 4indanao ,Region 9- 3,*91,$*) 193
Northern 4indanao ,Region 1*- $,7(7,5)5 196
Southern 4indanao ,Region 11- 5,1)9,335 $63
Central 4indanao ,Region 1$- $,59),$1* 179
%R44 $,(1$,159 $11
Caraga $,*95,367 111
Sour&e5 $*** Census o" 'opulation and 6ousing. National Statisti&s 78&e
Projected Population, by Five!ear "nterval,
P#ilippines$ 200020%0 &'edium Assumption(
4id9year 1oth Se:es 4ale ;emale
$*** 76,9(5,963 3),7(7,9)6 3),197,977
$**5 )5,$57,991($,))5,757 ($,37$,$3(
$*1* 9(,*11,791 (7,$6$,)*1 (6,7(),99*
$*15 1*$,96(,366 51,73$,665 51,$31,7*1
$*$* 111,7)3,$19 56,1$3,$)5 56,659,93(
$*$5 1$*,$$3,1*3 6*,31*,976 59,91$,1$7
$*3* 1$),1*6,95$6(,$*$,737 63,9*(,$15
$*35 135,3**,67967,7(1,339 67,559,3(*
$*(* 1(1,66),3(77*,)7*,()5 7*,797,)6$
Sour&e5 National Statisti&s 78&e
! "ana#ement of Resources and Enironment and Research
#.1 *ield Healt& Ser"ices Inor(ation S$ste(
*"=ectives:
To provide summary of data on health services delivery and selected program
accomplished indicators at the "arangay, municipality<city, district, provincial,
regional and national levels.
To provide data hich hen com"ined ith data from other sources, can "e used
for program monitoring and evaluation purposes.
To provide a standardi2ed, facility level data "ase hich can "e accessed for a
more in.depth studies
To ensure that the data reported to the 6H+&+ are useful and accurate and are
disseminated in a timely and easy to use fashion.
To minimi2e the recording and reporting "urden at the service delivery level in
order to allo more time for patient care and promotive activities.
Components:
6amily Treatment >ecord
Target Client 0ist
>eporting 6orms
*utput >eports
Treatment >ecord
The fundamental "uilding "loc1 of the 6ield Health +ervice information +ystem is
the Treatment >ecord. This is the document, form or pieces of paper upon hich the
presenting symptoms or complaints of the patient on consultation and the diagnosis,
treatment and date of treatment if recorded.
#.! Tar-et Settin- # involves the calculation of the eligi"le population. C)ligi"le population
consists of any group of people targeted for specific immuni2ations due to their suscepti"ility to
one or several diseases.E
#.# En"iron(ental Sanitation
&s defined as the study of all factors in man;s physical environment, hich may e!ercise a
deleterious effect on his health ell."eing and survival.
&ncluded in these factors are the folloing:
Aater sanitation
6ood sanitation
>efuse and gar"age disposal
)!creta disposal
&nsect vector and rodent control
Housing
'ir pollution
Noise
>adiological Protection
&nstitutional sanitation
+tream Pollution
MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAMS:
H)'0TH 'N5 +'N&T'T&*N
)nvironmental health and sanitation is still a health pro"lem in the country. 5iarrheal
diseases ran1ed first in the leading causes of mor"idity among the general population. *ther
sanitation related diseases are pneumonia, tu"erculosis, intestinal parasitism, schistosomiasis,
malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever hich are controlled and<or
eradicated "y health programs ith environmental sanitation components "ut still afflicting a
great num"er of the population.
A'T)> +4PP0@ 'N5 +'N&T'T&*N P>*?>'7
'pproved types of ater supply facilities:
0)()0 & (Point +ource$ # ' protected ell or a developed spring ith an outlet "ut
ithout a distri"ution system, generally adapta"le for rural areas here the house are
thinly scattered. ' 0evel 1 facility normally serves around 1/ to %/ households and its
outreach must not "e more than %/D meters from the farthest user. The yield or
discharge is generally from -D to 1-D liters per minute.
0)()0 && (Communcal 6aucet +ystem or +tand.Posts$ # ' system composed of a
source, a reservoir, a piped distri"ution netor1 and communcal faucets, located at not
more than %/ meters from the farthest house. The system is designed to deliver -D.:D
liters of ater per capital per day to an average of 1DD households, ith one faucet per -
to 8 households. ?enerally suita"le for rural areas here houses are clustered densely
to =ustify a simple piped system.
0)()0 &&& (Aateror1s +ystem or &ndividual House Connections$ # ' system ith a
source, a reservoir, a piped distri"utor netor1 and household taps. &t is generally suited
for densely populated ur"an areas. This type of facility re3uires a minimum treatment of
disinfection.
P>*P)> )KC>)T' 'N5 +)A'?) 5&+P*+'0 P>*?>'7
'pproved types of toilet facilities:
0)()0 & Non.ater carriage toilet facility # no ater is necessary to ash the aste into
the receiving space. )!amples are pit latrines, reed odorless earth closet.
Toilet facilities re3uiring small amount of ater to ash the aste into the receiving
space. )!amples are pour flush toilet and a3ua privies.
0)()0 && # on site toilet facilities of the ater carriage type ith ater.sealed and flush
type ith septic vault<tan1 disposal facilities.
0)()0 &&& # ater carriage types of toilet facilities connected to septic tan1s and<or to
seerage system to treatment plant.
&n rural areas, the C"lind drainageE type of asteater collection and disposal
facility shall continue to "e the emphasis until such time that seer facilities and
off.site treatment facilities shall "e made availa"le to clustered houses in rural
areas.
Conventional seerage facilities are to "e promoted for construction in
CPo"lacionsE and cities in the country as developmental o"=ectives to attain
control and prevention of fecal.ater."orne diseasesJ
*ther policies em"odied in Code of +anitation of the Philippines shall "e
pursued and enforced "y the local government units.
6**5 +'N&T'T&*N P>*?>'7
6our >ights in 6ood +afety
These four rights on food safety involve the chain in food processing from the source in
the mar1et until the food reaches the ta"le. They mainly encompass the folloing:
>ight +ource
>ight Preparation
>ight Coo1ing
>ight +torage
>ule in 6ood +afety: CAhen in 5ou"t, thro it outLE
H*+P&T'0 A'+T) 7'N'?)7)NT P>*?>'7
P>*?>'7 *N H)'0TH >&+H 7&N&7&M'T&*N 54) T* )N(&>*N7)NT'0 P*004T&*N
$ Ethico%moral Responsibility
%.1 Socioc,lt,ral 6al,es9 +elies9 Practices o Indi"id,als9 *a(ilies9 Gro,ps and
Co((,nities
%.! Code o Et&ics or Go"ern(ent :or;ers
>epu"lic 'ct No. 891,. 7arch %/, 1B:, 1non as the Code of Conduct and )thical
+tandards for Pu"lic *fficials and )mployees. This code upholds a time honored principle
that pu"lic office is a pu"lic trust. &t is the policy of the state to promote high standards of
ethics in pu"lic office. Pu"lic *fficials and employees shall at all times "e accounta"le to the
people and shall discharge their duties ith utmost responsi"ility, integrity, competence and
loyalty, act ith patriotism and =ustice, lead modest lives and uphold pu"lic interest over
personal interest.
%.# :HO9 'OH9 LGU Policies on Healt&
:HO Healt& polic$
>esearch Policy and Cooperation
Health systems
Health and development
National health accounts
Health information (Aestern Pacific >egion$
)vidence and &nformation for Policy
)nvironmental health policy ()uropean >egion$
7ental health policy, planning and service development
Health policy ()uropean >egion$
7edicines policy
+election and rational use of essential medicines
5rug access campaign
%.% Local Go"ern(ent Code
>.'. 918D, the 0ocal ?overnment Code, the responsi"ility for the delivery of "asic services
and facilities of the national government has "een transferred to the local government. This
involves the devolution of poers, functions and responsi"ilities to the local government
"oth provincial and municipal.
%.) Iss,es
& 'ersonal and 'rofessional (eelopment
).1 Sel Assess(ent o CHN Co(petencies9 I(portance9 Met&ods9 Tools
).! Strate-ies and Met&ods o Updatin- one<s sel9 en&ancin- co(petence in MCN and
related areas