HEALTH

1.

Political a. safety oppression people empowerment

“State of complete physical, mental and social well-being, not merely the absence of disease or infirmity” Major contributor to the overarching goal of poverty reduction 2.

b. c.

Socio-economic a. employment education housing

Determinants of Health • • • Affected by a combination of many factors Determined his circumstances and environment It is inappropriate therefore to blame or credit the persons state of health to himself alone because he is unlikely able to directly control many of these factors Knowledge of these factors is important in order to effectively promote health and prevent illnesses

b. c. 3.

Environment a. b. c. d. e. air food water urban/rural noise radiation pollution

Factors that make people healthy or not: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Income and social status Education Physical environment Employment and Working conditions Social support networks Culture Genetics Personal behavior and coping skills Health services Gender 5. 4.

f. g. Behavior a. b. c. d. Heredity a.

culture habits mores ethnic customs

genetic endowment i. ii. iii. defects strengths risks familial ethnic racial

PUBLIC HEALTH 6. •

iv.

Health Care Delivery System a. b. c. d. Promotive Preventive Curative Rehabilitative

“Science and Art of preventing disease, prolonging life, promoting health and efficiency through organized community effort for the sanitation of environment, control of communicable diseases, education of individuals in personal hygiene, organization of medical and nursing services for the early diagnosis and preventive treatment of disease and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity”.

Core business of Public Health FACTORS: 1. 2. disease control injury prevention

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3. 4. 5.

health protection health public policy promotion of health and equitable health gain

4. 5. 6. 7.

Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Develop a global partnership for development

ESSENTIAL PUBLIC HEALTH FUNCTIONS Needed to achieve the core business of public health

8.

Following are essential health functions: 1. 2. 3. 4. Health situation monitoring and analysis Epidemiological surveillance/disease prevention and control Development of policies and planning in public health Strategic management of health systems and services for population health gain Regulation and enforcement to protect public health Human resources development and planning in public health Health promotion, social participation and empowerment Ensuring the quality of personal and population based health services Research, development and implementation of innovative public health solutions

OVERVIEW OF THE PUBLIC HEALTH NURSING

Public Health Nursing and Community Health Nursing often used interchangeably

PHN defined by WHO: “Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of total public health programme for the promotion of health, improvement of the conditions in the social and physical environment, rehabilitation of illness and disability”

5. 6. 7. 8. 9.

CHN defined by Freeman: “Service rendered by a professional nurse with communities, groups, families and individuals at home, in health centers, in clinics, in schools and in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation”

GLOBAL AND COUNTRY HEALTH IMPERATIVES CHN defined by Jacobson Ongoing changes which exert a number of pressures on the public health system 1. 2. 3. Shifts in demographic and epidemiological trends in diseases New technologies for health care, communication and information Existing and emerging environmental hazards some associated with globalization Health reforms “Nursing practice in a wide variety of community services and consumer advocate areas and in a variety of roles at times including independent practice… community nursing is certainly not confined to public health nursing agencies”

The original thrust of Public Health Nursing: “Nursing for the health of the entire public/community versus nursing only for the public who are poor”

4.

United Nations General Assembly Standards of Public Health Nursing: Common vision Poverty reduction and sustainable development in September 2000 Public Health Nursing • Exemplified by Millennium Development Goals which are based on the fundamental values of freedom, equality, solidarity, tolerance, health, respect for nature and shared responsibility: 1. 2. 3. Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Public Health Nurses Refers to the practice of nursing in national and local government health departments and public schools It is a community health nursing practice in the public sector

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Refers to the nurses in the local/national health departments or public schools whether their official position title is public health nurse or nurse or school nurse

• • •

Mandated as the lead agency in health Maintains specialty hospitals, regional hospitals and medical centers Maintains provincial health teams made up of DOH representatives to the local health boards and personnel involved in CDC, specifically for malaria and schistosomiasis

PUBLIC HEALTH NURSES • • Leaders in providing quality health services to the communities First level of health workers to be knowledgeable about new public health technologies and methodologies Usually the first ones to be trained to implement new programs and apply new technologies

Philippine General Hospital • Part of national level which provide health care services

Local level (Local Health System) THE PHILIPINE HEALTH CARE DELIVERY SYSTEM Major players of the HCDS 1. Private sector a. b. c. d. Largely market oriented Health care is paid through user fees at the point of service Includes profit and non-profit health providers Includes providing health services in i. ii. iii. e. Clinics Hospitals Health insurance • Run by LGU

Provincial government • Provincial and District hospitals

City/Municipal government • • Health centers/RHU Barangay health stations

Local Chief Executive • • Chaired the local health board Function is mainly to serve as advisory body to the local executive and the sanggunian or local legislative council on health-related matters

Manufacture of i. ii. iii. iv. v. vi. vii. Medicines Vaccines Medical supplies Medical equipment Other health and nutrition products Research and development Human resource development 1888 •

PHILIPPINE DEPARTMENT OF HEALTH HISTORICAL BACKGROUND PRE-SPANISH and SPANISH PERIOD

2.

Public sector a. largely financed through a tax-based budgeting system at both national and local levels health care is generally given free at the point of service consist of the national and local government agencies

Superior board of health and charity was created by the Spaniards which established a hospital system and a board of vaccination

b. c.

June 23, 1898 • Department of Public Works, Education and Hygiene was created by virtue of decree signed by President Emilio Aguinaldo

September 29, 1898 • NATIONAL LEVEL Department of Health July 1, 1901 General Orders No. 15 established the Board of Health for the City of Manila

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Act No. 157 created Board of Health for the Philippine Islands, also functioned as the Local Health Board of Manila

April 13, 987 • EO No. 119 transformed the Ministry of Health back to the Department of Health

December 2, 1901 • Act Nos. 307, 308 established the Provincial and Municipal Boards completing the health organization in accordance with the territorial division of the islands Board of Health for the Philippine Islands became Insular Board of Health

October 10, 1991 • RA 7160 (Local Government Code) provided for the decentralization of the entire government; DOH changed its role from one of implementation to one of governance

October 26, 1905 • Act No. 1407 abolished the Insular Board of Health and replaced by the Bureau of Health under the Department of Interior Act No. 1487 (1906) replaced the provincial boards of health with district health officers

May 24, 1999 • EO No. 102 (Redirecting the Functions and Operations of the DOH) granted the DOH to proceed with its Rationalization and Streamlining Plan. Mandates the DOH to provide assistance to LGU, people’s organization and other members of civic society in effectively implementing programs, projects and services that will o Promote the health and well being of every Filipino; Prevent and control diseases among population at risk; Protect individuals, families and communities exposed to hazards and risks; Treat, manage and rehabilitate individuals affected by diseases and disability

1915 • Act No. 2468 transformed the BOH into a commissioned service called the Philippine Health Service

o o

1932 • Act No. 4007 (Reorganization Act of 1932) reverted back the Philippine Health Service into the Bureau of Health and combined the Bureau of Public Welfare under the Office of the Commissioner of Health and Public Welfare 1999-2004 PHILIPPINE COMMONWEALTH AND THE JAPANESE OCCUPATION (1935-1945)

o

Development of Health Sector Reform Agenda

May 31, 1939 • Commonwealth Act No. 430 created the Department of Public Health and Welfare

ROLES AND FUNCTIONS OF DOH (Mandated by the EO No. 102) ROLE Providing technical and other resource assistance

January 7, 1941 GENERAL FUNCTIONS UNDER THREE SPECIFIC ROLES • EO No. 317 fully implemented Commonwealth Act No. 430 1. 2. 3. Leadership in Health Enabler and Capacity Builder Administrator of Specific Services

January 1, 1951 • Office of the President of the Sanitary District was converted into RHU carrying out 7 basic health services; Maternal and Child Health, environmental Health, CDC, Vital Statistics, Medical Care, Health Education and Public Health Nursing

February 20 1958 • EO No. 288 effort to decentralize governance of health service. An office of the regional health director was created in 8 regions and all health services were decentralized to the regional, provincial and municipal levels

VISION The DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines

1970 • Restructured Health Care Delivery System was conceptualized, classified health services into Primary, Secondary and Tertiary

MISSION Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health

June 2, 1978 • PD 1397 renamed the Department of Health to the Ministry of Health GOAL: Health Sector Reform Agenda (HSRA) Health Sector Reform is the overriding goal of the DOH. Support mechanisms will be through sound organizational development, strong policies, systems and procedures, capable of human resources and adequate financial resources

December 2, 1982 • EO No. 851 created Integrated Provincial Health Office

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Rationale for Health Sector Reform 1. 2. Slowing down in the reduction in the IMR and the MMR Persistence of large variations in health status across population groups and geographic areas High burden from infectious diseases Rising burden from chronic and degenerative diseases Unattended emerging health risks from environmental and work related factors Burden of disease is heaviest on the poor

General Objective: FOURmula ONE for Health is aimed at achieving critical reforms with speed, precision and effective coordination directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by Filipinos, especially the poor.

3. 4. 5.

Specific Objectives: Fourmula One for Health will strive, within the medium term, to: • • • • Secure more, better and sustained financing for health Assure the quality and affordability of health goods and services Ensure access to and availability of essential and basic health packages Improve performance of the health system

6.

Reason for the existence of the above conditions 1. Inappropriate health delivery system – shown by an inefficient and poorly targeted hospital system ineffective mechanism for providing public health programs on top of health human resources maldistribution Inadequate regulatory mechanisms for health services resulting to poor quality of health care, high cost of privately provided health services, high cost of drugs and presence of low quality of drugs in the market Poor health care financing and inefficient sourcing or generation of funds for healthcare

Defining the Rules of Engagement: Seven (7) General Guidelines for Health Reform Implementation F1 Rule No.1: FOURmula ONE for Health will organize the critical reform initiatives into four implementation components, namely, Financing, Regulation, Service Delivery and Governance. F1 Rule No. 2: The implementation of FOURmula ONE for Health will focus on a few manageable and critical interventions. Such interventions will be identified using the following criteria:

2.

3.

Framework for the implementation of HSRA: FOURmula ONE for Health

• • • •

Doable given available resources - Critical interventions identified for each component must be deemed doable given the available time, human and financial resources. Sufficient groundwork and buy-in - The chosen interventions must be backed by sufficient groundwork and buy-in from implementation partners, especially in the development of reform packages for local implementation. Triggers a reform chain reaction - These critical interventions must be able to trigger a chain of reaction that will spur the implementation of other FOURmula ONE for Health interventions, within and across the four components. Produces tangible results and generates public support - These critical interventions must be able to show tangible results within the immediate and medium terms, which in turn generate support and cooperation from the public;

FOURmula ONE for Health is the implementation framework for health sector reforms in the Philippines for the medium term covering 2005-2010. It is designed to implement critical health interventions as a single package, backed by effective management infrastructure and financing arrangements.

FOURmula ONE for Health engages the entire health sector, including the public and private sectors, national agencies and local government units, external development agencies, and civil society to get involved in the implementation of health reforms. It is an invitation to join the collective race against fragmentation of the health system of the country, against the inequity of healthcare and the impoverishing effects of ill-health. With a robust and united health sector, we can win the race towards better health and a brighter future for generations to come.

F1 Rule No. 3: The reforms will be implemented under a sector-wide approach, which encompasses a management perspective that covers the entire health sector and an investment portfolio that encompasses all sources. F1 Rule No. 4: The National Health Insurance Program (NHIP) will serve as the main lever to effect desired changes and outcomes in each of the four implementation components, where the main functions of the NHIP including enrollment, accreditation, benefit delivery, provider payment and investment are employed to leverage the attainment of the targets for each of the reform components. F1 Rule No. 5: The functional and financial management arrangements will be defined in terms of specific offices having clear mandates, performance targets and support systems,

Goals of FOURmula one for Health Starting the Race with the End in Mind: Fourmula One for Health Goals and Objectives Over-all Goals: The implementation of FOURmula ONE for Health is directed towards achieving the following end goals, in consonance with the health system goals identified by the World Health Organization, the Millennium Development Goals, and the Medium Term Philippine Development Plan: • • • Better health outcomes More responsive health system More equitable healthcare financing.

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within well-defined time frames in the implementation of reforms within each component. F1 Rule No. 6: The functional clustering of teams and assignment of specific Team Leaders shall facilitate implementation, monitoring and supervision in a coordinative manner and shall not, in any way, prejudice the corporate nature of the DOH-attached agencies nor the autonomy of Local Government Units.

Governance in local health systems may be improved by undertaking the following strategies: FOUR-IN-ONE Convergence Sites have to be established. These convergence sites will undertake integrated implementation of FOURmula ONE for Health components in appropriately delineated localities or inter-local health zones.

A FOURmula ONE for Health LGU Scorecard will be developed and employed to track the progress and compare the performance of various localities or inter-local health zones. F1 Rule No. 7: The selection of FOUR-in-ONE Convergence Sites will be governed by the following criteria:

A FOURmula ONE for Health Professional Development and Career Track will be institutionalized where competent and dedicated health personnel will provide quality health services and sound advice to local chief executives with regard to health reforms.


• •

Willingness of the LGU to participate in the FOURmula ONE for Health implementation, in terms of willingness to provide the requisite counterpart resources, and willingness to enter into formal national government to local government, inter-local government and government to private sector networking, partnership and resource sharing arrangements; Presence of local initiatives or start-up activities relevant to FOURmula ONE strategies, to include, but not limited to: development of inter-local health zones, enrollment of indigents into the social health insurance system, improvement in drug management systems, among others; Relatively high feasibility of success and sustainability, to include factors such as capacity to enter into loans, capacity to absorb investments and sustain the reform process, etc.; and Availability of funds from GOP and external sources for capital investment requirements. PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH CARE SERVICE

PRIMARY HEALTH CARE  Essential health care made universally accessible to individuals and families in the community by means of acceptable 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 was declared during the First International Conference on PHC held in Alma Ata USSR on September 6 – 12, 1978 by WHO with a goal of “Health for All by the year 2000” Primary Health Care was adopted in the Philippines through LOI 949 signed by Pres. Marcos on October 19, 1979 and has an underlying theme of “Health in the hands of the People by 2020”

Carrying out the Game Plan: Winning Strategies to Attain FOURmula ONE for Health ComponentSpecific Objectives

 F1 Component No. 1: HEALTH FINANCING Objective: The objective of financing reforms under FOURmula ONE for Health is to secure more, better and sustained investments in health to provide equity and improve health outcomes, especially for the poor.

Concept of PHC is characterized by;


F1 Component No.2: HEALTH REGULATION Objective: The main objective of health regulation under FOURmula ONE for Health is assuring access to quality and affordable health products, devices, facilities and services, especially those commonly used by the poor. F1 Component No. 3: HEALTH SERVICE DELIVERY Objective: FOURmula ONE for Health interventions in service delivery are aimed at improving the accessibility and availability of basic and essential health care for all, particularly the poor. This shall cover all public and private facilities and services F1 Component No.4: GOOD GOVERNANCE IN HEALTH

Partnership and empowerment of the people  PHC is a strategy


which focuses responsibility for health on the individual, his family and the community

PHC includes full participation and active involvement of the community

towards the development of self-reliant people, capable of achieving an acceptable level of health and well being


Objective: The objective of good governance in health is to improve health systems performance at the national and local levels. FOURmula ONE for Health will introduce interventions to improve governance in local health systems, improve coordination across local health systems, enhance effective private-public partnership, and improve national capacities to manage the health sector.

PHC recognizes the interrelationship between health and the overall political, socio-cultural and economic development of society

Elements/Components of PHC

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1. 2. 3. 4. 5. 6. 7. 8. 9. Strategies 

Environmental Sanitation Control of communicable diseases Immunization Health Education 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

a. b. c. d.

General medical practitioners PHN RSI RHM

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM  Primary Level of Care o o Devolved to the cities and municipalities Health care provided by the center physicians, PHN, RHM, BHW, TBAs and others Usually the first point of contact between the community members and other levels of health facility

o

Reorientation and reorganization of the national health care system (RA 7160) Effective preparation and enabling process for health action at all levels Mobilization of the people  with the end view of providing appropriate solutions leading to self-reliance and self determination

Secondary Level of Care o o Given by physicians with basic health training Usually given in health facilities either privately owned or government operated such as infirmaries, municipal and district hospitals, out-patient departments of provincial hospitals Serves as a referral center for the primary health facilities Capable of performing minor surgeries and perform some simple laboratory examinations

 

o o

Development and utilization of appropriate technology  focusing on local indigenous resources available in and acceptable to the community

Tertiary Level of Care o Rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals and specialized hospitals Referral center for the secondary care facilities

  

Organization of communities arising from their expressed needs Increase opportunities for community participation Development of intra-sectoral linkages with other government and private agencies Emphasizing partnership 

o

LEVELS OF HEALTH CARE SERVICES  Tertiary level care facilities o Framework for meeting the goal of PHC o Medical centers Teaching and Training hospitals National and Regional Health Services

Organizational strategy o calls for active and continuing partnership among the communities, private and government agencies in health development

o 

Secondary level care facilities o o Provincial / City health services and hospitals Emergency and District hospitals

Four cornerstones/Pillars in PHC 1. 2. 3. 4. Active community participation  Intra and Inter-sectoral linkages

Primary level care facilities o RHU Community hospitals & health centers Private practitioners, puericulture centers BHS

Use of appropriate technology o Support mechanisms made available o

Two levels of PHC workers o 1. 2. Village or Barangay Health Workers Intermediate Level Health Workers THE PUBLIC HEALTH NURSE

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 Qualifications and Functions Must be professionally qualified and licensed to practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA 9173) • Management function – – • Inherent in the practice of PHN Organizes the nursing service of the local health agency   

The PHN visits the patient

Bag technique  Tool by which the nurse during her visit will enable her to perform a nursing procedure with ease and deftness, save time and effort Most important principle Minimize if not prevent the spread of any infection Important points to consider in the use of the bag Contain all necessary articles Cleaned very often Well protected Arrangement-most convenient

Supervisory function – Supervisor of the midwives and other health workers

Nursing care function – – – Inherent function of the nurse Based on the science of art and caring Caring for all levels of clientele toward health promotion and disease prevention

ASSESSING COMMUNITY HEALTH NEEDS

Collaborating and coordinating function – – Care coordinators for communities and their members Establishes linkages and collaborative relationships with other health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems

COMMUNITY HEALTH NURSING • COMMUNITY – • HEALTH – Goal Primary client

Health promotion and education function – Activities goes beyond health teachings and health information campaigns

NURSING – Means

Training function – Initiates the formulation of staff development and training programs for midwives and other auxiliary workers COMMUNITY

Research function • – Participates in the conduct of research and utilizes research findings in her practice • • Disease surveillance – Measure the magnitude of the problem Measure the effect of the control program – • • Group of people sharing common geographic boundaries, common values and interest Functions within a particular socio-cultural context, which means that no two communities are alike Primary client of CHN – – Has a direct influence on the health of the individual, families and sub-populations It is at this level that most health service provision occurs

Regarded as an organism with its own stages of development – Matures through time

NURSING PROCEDURES  Clinic visit  Patient visits the health center Most common is BP measurement  Home visit –  Family-nurse contact Will serve as a basis of health programs and services to be delivered to the community

COMMUNITY DIAGNOSIS

Done to come up with a profile of local health situation

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Starts with determining the health status of the community

• •

Transportation system Educational level Housing conditions

PROCESS OF COMMUNITY DIAGNOSIS • Consists of; – Collecting, organizing & synthesizing data • In order to identify the different factors that may directly or indirectly influence the health of the population –

Economic indicators • • • • Poverty level income Employment rate Types of industry present in the community Occupation common in the community

Analyzing & interpreting health data • Seek explanations for the occurrence of health needs and problems of the community –

Environmental indicators • Physical/geographical/topographical characteristics Water supply Waste disposal Air, Water and Land pollution

Formulation of Community Health Nursing Diagnoses • Will become the bases for developing and implementing community health nursing interventions and strategies • • • –

Types of Community Diagnosis • Comprehensive community diagnosis – • Aims to obtain general information about the community

Cultural factors • Variables that may break up people into groups within the community e.q. – – – Ethnicity Social class Language Religion Race Political orientation

Problem Oriented community diagnosis – Responds to a particular need

ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS 1. DEMOGRAPHIC VARIABLES – Total population & Geographical distribution including UrbanRural index & Population Density Age & Sex composition Selected vital indicators e.q. Growth rate, CBR, CDR & Life expectancy rate Patterns of migration Population projection • •

– – –

– –

Cultural beliefs and practices that affect health Concepts about Health and Illness

– – • Note: –

3.

HEALTH & ILLNESS PATTERNS – – Leading cause of mortality Leading cause of morbidity Leading cause of infant mortality Leading cause of maternal mortality Leading cause of hospital admission

Population groups that need special attentions: • • • Indigenous people Internal refugees Socially dislocated groups as a result of disasters, calamities & development programs 4.

– – –

HEALTH RESOURCES – – Manpower resources Material resources

2.

SOCIO-ECONOMIC & CULTURAL VARIABLES – Social indicators • Communication network

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5.

POLITICAL/LEADERSHIP PATTERNS – Reflects the action potential of the state and its people to address the health needs and problems of the community Mirrors the sensitivity of the government to the people’s struggle for better lives DEMOGRAPHY • – Science which deals with the study of the human population’s – – Size Composition Distribution in space

IDENTIFYING COMMUNITY HEALTH NURSING PROBLEMS  Health Status Problems Increased/decreased morbidity, mortality fertility or reduced capability for wellness  Health Resources Problems • Lack of or absence of manpower, money, materials or institutions necessary to solve health problems  Health Related Problems Existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community • •

SOURCES OF DEMOGRAPHIC DATA -Can be obtained from a variety of sources Censuses Sample surveys Registration systems

Two ways of assigning people when the census is being taken De jure

PRIORITY-SETTING • Nature of the condition/problem presented – Classified as health status, health resources or health related problems

Done when people are assigned to the place where they usually live regardless of where they are at the time of the census

De facto • People are assigned to the place where they are physically present at the time of the census regardless of their usual place or residence

Magnitude of the problem – Severity of the problem which can be measured in terms of the proportion of the population affected by the problem

POPULATION SIZE • • • Refers to the number of people in a given place or area at a given time Allows the nurse to make comparisons about population changes over time Helps rationalize the types of health programs or interventions which are going to be provided for the community

Modifiability of the problem – Probability of reducing, controlling or eradicating the problem

Preventive potential – Probability of controlling or reducing the effects posed by the problem

Social concern – Perception of the population or the community as they are affected by the problem and their readiness to act on the problem

TWO METHODS IN DETERMINING POPULATION SIZE Method 1 • Determining the increase in the population resulting from excess of births compared to deaths

Application of Public Health Tools NATURAL INCREASE • Difference between the number of births and the number of deaths occurring in a population in a specified period of time Nat. increase = no. births – no. of deaths / specified year RATE OF NATURAL INCREASE • Difference between the CBR and the CDR occurring in a population in a specified period of time Rate of Nat. increase = CBR – CDR / specified year

COMMUNITY HEALTH NURSING • Three important tools

The health disciplines of • • • Demography Vital statistics Epidemiology

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The sex ratio represents the number of males for every 100 females in the population Method 2 • Determine the increase in the population using data obtained during two census periods. This implies that the increase in the size of the population is not merely attributed to excess in births but also the effect of migration

AGE COMPOSITION • Two ways to describe the age composition of the population

MEDIAN AGE ABSOLUTE INCREASE PER YEAR • • Measures the number of people that are added to the population per year. DEPENDENCY RATIO Abs. Increase/year = Pt – Po / t • • where: – – – • Method 2 Pt = pop. Size at a later time Po = pop. Size at an earlier time t = no. of years between 0 and time t. • • Compares the number of economically dependent with the economically productive group in the population. Economically dependent – – 0 – 14 65 and above Divides the population into two equal parts.

Economically productive – Within 15 – 64 age group

RELATIVE INCREASE • Actual difference between the two census counts expressed in percent relative to the population size made during an earlier census Relative increase = Pt – Po / Po • where: – – Pt = population size at a later time Po = population size at an earlier time 1. 2. 3. POPULATION DISTRIBUTION • The measures help the nurse decide how meager resources can be justifiably allocated based on concentration of population in a certain place Urban-Rural distribution Crowding Index Population Density

POPULATION COMPOSITION Pertaining to population size’s variables such as: • • • • • • Age

VITAL STATISTICS • Refers to the systematic study of vital events such as births, illnesses, marriages, divorces/separations and deaths Tool in estimating the extent or magnitude of health needs and problems in the community Common health indicators Fertility rates – – • Crude birth rate (CBR) General fertility rate (GFR)

• Sex Occupation Educational level Commonly described in terms of its age and sex Nurse utilizes data on age and sex composition to decide who among the population groups merits attention in terms of health services and programs • •

Mortality rates – Crude death rate (CDR) Specific mortality rate (SMR) Cause of death rate Infant mortality rate (IMR) Maternal mortality rate (MMR) Proportionate mortality rate (PMR)

SEX COMPOSITION –


To describe the sex composition of the population, the nurse computes for the “sex ratio” Sex ratio compares the no. of females in the population Sex ratio = Number of males / Number of females

– – – –

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– – •

Swaroops index Case fatality rate (CFR)

• •

Disease development does not rest on a single cause Health conditions result from a multitude of factors

Morbidity rate – – Incidence rate Prevalence rate

Model that explain the MCT – AGENT • Any element, substance or force, either animate or inanimate. The presence or absence of which may serve as stimulus to initiate or perpetuate a disease process – Disease process happens only when the agent comes in contact with a susceptible host and under proper environmental conditions Intrinsic property of microorganism to survive and multiply in the environment to produce disease Ecologic Triad/Epidemiologic triangle

MORBIDITY • TEN LEADING CAUSES OF MORBIDITY No. & Rate/100,000 Population PHILIPPINES, 2002 MORBIDITY (2002)

HOST • • Any organism that harbors and provides nourishment for another organism Characteristics of the host will affect his or its risk of exposure to sources of infection and his or its susceptibility or resistance Intrinsic factors of the host – – MORTALITY • Ten Leading Causes of Mortality by Sex Number, Rate/100,000 Population & Percentage Philippines, 2002 MORTALITY – – – – – EPIDEMIOLOGY • • EPIDEMIOLOGY Study of the occurrence and distribution of health conditions such as disease, deformities or disabilities on human populations Two main areas of concern – – Study of occurrences and distribution of diseases Search for the determinants (causes) of the disease and its observed distributions • • • – Genetic Age Sex Ethnic group Physiologic Immunologic experience (immunization) Inter-current or pre-existing disease Human behavior

RESISTANCE Specific – Results from an immunologic experience such as; immunization or vaccination

Non-specific – Results from an intact skin, mucous membrane, reflexes as lacrimation, coughing, diarrhea or vomiting Can be maintained through personal hygienic practices, environmental sanitation, proper nutrition and a healthy lifestyle

Backbone of the prevention of diseases

Epidemiology rests on two important concepts; • • Multiple Causation Theory Levels of Prevention of Health Problems

• •

COMMUNITY Community as a host – Protects its health by the nurse by increasing its herd immunity

• Multiple Causation Theory

Herd Immunity – Probability of a group or community developing an epidemic introduction of an infectious agent

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It is the proportion of the immunes and the susceptible in the group

Interrupt the chain of infection through environmental manipulation Prevention of spread to human reservoirs and other susceptible human hosts

• ENVIRONMENT • • Sum total of all external conditions and influences that affect the life and development of an organism Affects the agent and the host

Primary prevention can be done through; – – – Personal surveillance Quarantine Segregation or isolation

Three components of environment – Physical environment • Composed of the inanimate surroundings e.q. geophysical conditions or the climate •

Health promotion activities include; – – Provision of proper nutrition Safe water supply and waste disposal system Vector control Promotion of a healthy lifestyle Good personal habits

Biological environment – • Makes up the living things around us e.q. plant and animal life Human population • – –

• –

Socio-economic environment • May be in the form of level of economic development of the community, presence of social disruptions

Specific measures include provision of; – – Immunization Prophylaxis to vulnerable or at-risk groups

LEVELS OF PREVENTION OF HEALTH PROBLEM • • Promoting health and Preventing health problems Make up most of the nurse’s activities in the community

SECONDARY PREVENTION • Aims to identify and treat existing health problems at the earliest possible time Interventions can still lead to the control or eradication of the health problem – Screening Case finding Disease surveillance Prompt and appropriate treatment

PREVENTION – • • Refers to identification of potential problems – Directed to the healthy population – – Primordial prevention • • Focusing on prevention of emergence of risk factors In Communicable disease control;

– –

Specific protection • Removal of the risk factors or reduction of their levels

Health education on signs and symptoms will enable the client to identify illness and seek early care or treatment Knowledge of risk behaviors that contribute to the spread of the disease may influence patients and the families to modify this behavior and, thus, assist in the prevention of disease

PRIMARY PREVENTION TERTIARY PREVENTION • In Communicable disease prevention • – Activities on primary prevention are targeted at intervening before the agent enters the host and cause pathological changes It aims to; • • • strengthen the host resistance – Inactivate the agent (source of infection) E.q hearing impairment from frequent ear infections Infectious diseases Limits disability progression – The nurse attempts to reduce the magnitude or severity of the residual effects of;

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Non-communicable diseases – Mental illness, CVD •

Done to look for previously unidentified cases of diseases

Screening & Case Finding – Should consider the sensitivity and specificity of the tests

Day care centers and sheltered workshops are examples of opportunities to achieve the objective of tertiary prevention in mental illness and drug abuse

• •

ASPECT 1 SENSITIVITY – Proportion of persons with a disease who test positive on a screening test Measures the probability of the test correctly identifying a positive case of a disease

THE EPIDEMIOLOGICAL APPROACH • 1. PHASES

– Descriptive epidemiology • 2. Concerned with disease distribution and frequency •

SPECIFICITY – Proportion of a persons without a disease who have negative results on a screening test Measures the probability of correctly identifying non-cases

Analytical epidemiology • Attempts to analyze the causes or determinants of disease through hypothesis testing •

3.

Intervention or Experimental epidemiology • Answers questions about the effectiveness of new methods for controlling diseases or for improving underlying conditions

ATTACK RATE – Used to calculate an identifiable population exposed to an infectious agent Represents the incidence of the illness among the exposed population Frequently used in surveillance and control of communicable diseases ASPECT 2

4.

Evaluation epidemiology • Attempts to measure the effectiveness of different health services and programs

– DESCRIPTIVE EPIDEMIOLOGY II. Aspects involved in descriptive epidemiology 1. Observation and recording of existing patterns of occurrence of the health condition under study Description of the disease/condition as to person, place and time characteristics Analysis of the general pattern of occurrence of the disease or condition ASPECT 1 Observation and recording of existing patterns of occurrence of the health condition under study

Description of the disease/condition as to person, place and time characteristics – After the disease or condition has been identified with reasonable certainty; the number of persons who possess the disease are recorded noting down the; • • • Characteristics of the afflicted persons Time the disease was initially recognized Characteristics of the place where the cases came from

2.

3. • I.

• 1.

ASPECT 2 Herd Immunity

In order to describe the occurrence of disease condition; the nurse needs to recognize or identify the disease with reasonable certainty • Done by conducting – – Screening Case finding activities

Basis for determining the community’s reaction against disease invasion since it represents the immunity and susceptibility levels of individuals comprising the population The immunity level is inversely proportional to susceptibility level

2.

EXPOSURE or CONTACT RATE

• •

ASPECT 1 SCREENING – Presumptive identification of unrecognized diseases or defects through the application of diagnostic tests or laboratory examinations and clinical assessment

Represents opportunities for progressive opportunities for progressive transfer or transmission of an infectious agent to a susceptible host and depends on the; • • Frequency of contact Facility of transmission

CASE FINDING

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3.

CHANCE – Probability of contact between the – • • – Source of infection Place

Characteristics of the individual who were exposed and who contacted the infection or the disease

• Susceptible host

Features, factor or conditions which existed in or described the environment in which the disease occurred

Depends upon the • • • • Number of sources of infection • Number of immunes – Location of the source of infection • Endemic occurrence – Continuous occurrence throughout a period of time • Malaria – Palawan Schistosomiasis – Leyte and Samar Filariasis – Sorsogon Tuberculosis – all specific areas of the country Intermittent occurrence (rabies) Sporadic Patterns of occurrence and distribution

Disease occurrence can be described by the following: A) Short time fluctuations common in epidemics – Common source epidemic – characterized by simultaneous exposure of a large number of susceptible to a common infectious agent Propagated epidemic – caused transmission of disease agent by a person-to-person • • Epidemic occurrence – C) Secular variation – refers to changes in disease frequency over a period of many years • • 3. ASPECT 3 – Analysis of the general pattern of occurrence of the disease or condition – Establishing the • • – Disease frequency Disease distribution in a population PUBLIC HEALTH PROGRAMS  Sets of interventions put together to operationalize policies and standards directed towards the prevention of certain public health problems Family Health Non-communicable Disease Prevention and Control Communicable Disease Prevention and Control Environmental Health and Sanitation Other priority health programs      • Period during which the cases of the disease being studied were exposed to the source of infection and the period during which the illness occurred FAMILY HEALTH  – Persons  Concerned with the health of the mother, unborn, newborn, infant, child, adolescent and youth, adult men and women and older persons Basic unit of the community Sentrong Sigla Herbal Medicine Health Emergency Preparedness and Response Program National Voluntary Blood Services Program Botika ng Barangay Simultaneous occurrence of epidemic of the same disease in several countries Unusually large number of cases in a relatively short period of time

• •

B)

Cyclic variation – refers to recurrent fluctuations of disease that may exhibit cycles lasting for certain periods

Pandemic occurrence

Defining the characteristics of the disease or condition in relation to  • • • Time  Place Person   

Correlating the data and formulate a causal association between the • • Disease under study Probable factors surrounding it

• •

DISEASE DISTRIBUTION Variables affecting disease distribution – Time

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 

Aims to: Improve the survival, health and well being of mothers and the unborn     Pre-pregnancy Prenatal Natal Postnatal stages

Prenatal visits

Period of pregnancy

   

1st visit

As early in pregnancy as possible before four months or during the first trimester During the 2nd trimester During the 3rd trimester After 8th month of pregnancy till delivery

2nd visit 3rd visit Every two weeks

  

Reduce morbidity and mortality rates:   Children 0-9 years old Among Filipino adults and older persons and improve quality life Mortality from preventable causes among adolescents and young people

MICRONUTRIENT SUPPLEMENTATION Vitamins Dose Schedule Remarks

Vitamin A 10,000 IU MATERNAL HEALTH PROGRAM Tasked to reduce MMR by three quarters by 2015 to achieve MDG    Maternal Mortality Rate (2003) Iron CAUSE Other Complications related to pregnancy occurring in the course of labor, delivery and puerperium   Hypertension complicating pregnancy, childbirth and puerperium (25%) Postpartum hemorrhage (20.3%) Pregnancy with abortive outcome (9%) Hemorrhage related to pregnancy Strategic thrusts for 2005-2010 Launch and implement Basic Emergency and Obstetric Care (BEMOC) strategy in coordination with DOH  Entails establishment of facilities that provide emergency obstetric care for every 125,000 population and which are located strategically

2x a week starting on the 4th Do not give Vitamin A month of pregnancy before 4th month of pregnancy. It might cause congenital problems in the baby

60mg/400 ug Daily tablet

Recommended Schedule for Post Partum Care Visits

 

1st visit


1st week post partum preferably 3-5 days 6 weeks post partum

    

2nd visit

FAMILY PLANNING PROGRAM  Annual Population Growth    2.36%

Population expected to double in 29 years Total fertility rate    3.5 children/woman 3 to 4 million getting pregnant/year 85% expected to progress full term

Improve quality of prenatal and postnatal care  Pregnant women should have at least four (4) prenatal visits

Reduce women’s exposure to health risks  Institutionalization of responsible parenthood 

National Demographic and Health Survey (2003)

Stakeholders must advocate for health  Resource generation and allocation for health services


 

44% women got pregnant with 1st child ages 20-24 6.1% Ages 15-19 35-39 – highest percentage of using contraceptives 15-19 – lowest percentage

ANTENATAL REGISTRATION Married women

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48.8% - use any form of contraceptive method   33.4% - modern method 15.5% - traditional method 

Simple fertility awareness based method Cervical secretions as an indicator of fertility Checking the presence of secretions daily

51.1% - do not use any form of contraceptive method

Standard days method  Users with menstrual cycle between 26 and 32 days are counseled to abstain from SI on days 8-19 to avoid pregnancy

FAMILY PLANNING METHODS  Female sterilization   Cutting or blocking two fallopian tubes (BTL)

CHILD HEALTH PROGRAMS Main goal is to reduce morbidity and mortality rates for children 0-9 years old   Strategic thrusts for 2005-2010 Pursuing the sentrong sigla initiative Apply REB strategy for immunization Intensify health education and information campaign IMCI and BEMOC strategy Implementation of laws and policies for the protection of newborns  Early Childhood Development Act of 2000 Newborn Screening Act of 2004 EO 286, Bright Child Program EO 51, Milk Code Rooming-in and Breastfeeding Act

Male sterilization  Vas deferens is tied and cut or blocked through a small opening on the scrotal skin (Vasectomy) Effective 3 months after the procedure

  Pill

     Hormones – estrogen and progesterone  Taken daily PO  Male condom    Injectables Thin sheath of latex

 Dual protection from STIs including HIV    Synthetic hormone – progestin which suppresses ovulation, thickens cervical mucus 

LAM  Postpartum method of postponing pregnancy based on physiological infertility experienced by breast feeding women Effective only for a maximum of 6 months postpartum  Infant and Young Child Feeding (IYCF)  Global Strategy for IYCF issued jointly by the WHO and UNICEF in 2002 as endorsed by the World Health Assembly in May 2002 and the UNICEF Executive Board in September 2002 Strategy calls for the:  Promotion of breastmilk as the ideal food for the healthy growth and development of infants Exclusive breastfeeding for the first 6 months of life

 

Mucus/Billings/Ovulation   Abstaining from SI during fertile days Can not be used by woman with unusual disease or condition that results in extraordinary vaginal discharge that makes observation difficult

 

Overall objective:  Improve the survival of infants and young children by improving their nutritional status, G & D through optimal feeding

BBT  Identifying the fertile and infertile period by daily taking and recording rise in BT during and after ovulation Temp is taken 3 hours of undisturbed rest (usually morning) 

National Plan of Action for 2005 – 2010 for IYCF

Sympto-thermal method  Combination of BBT and Billing/Mucus method

GOAL  Reduce Child Mortality Rate by 2/3 by 2015

Two day method

OBJECTIVE

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Improve health and nutrition status of infants and young children

Schools  Introducing the “breastfeeding culture”

OUTCOME Laws that protects IYCF  Improve exclusive and extended breast feeding and complementary feeding    EO 51, Milk Code Rooming-in and Breastfeeding Act of 1992 RA 8976, Food Fortification Law of 2000

Specific Objectives  70% of newborns are initiated to breastfeeding within one hour after birth 60% of infants are exclusively breastfed up to 6 months

 

EXPANDED PROGRAM IMMUNIZATION 90% of infants are started on complementary feeding by 6 months of age Median duration of breastfeeding is 18 months   General principles which apply in vaccinating children Safe and immunologically effective to administer all EPI vaccine on the same day at different sites of the body Measles vaccine should be given as soon as the child is 9 months old     National IYCF strategy   Health Facilities   Mother-baby friendly hospitals  Health workers  Advocates Protectors Promoters of IYCF Enforcers of laws, not violators  Family/Community       Supportive family Milk Code “vigilantes” Lay/Peer counselors IYCF “bayanihan” spirit Mother-baby friendly public places  Working places     Industry  Comply with the “Code” Maternity leave Lactation/Breastfeeding room Breastfeeding breaks  No extra doses must be given to children who missed a dose of DPT/HB/OPV/TT Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other than the diluents supplied with them Repeat BCG vaccination if the child does not develop a scar after the 1st injection Use one syringe one needle per child during vaccination Routine Immunization Schedule for Infants    DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose Vaccines containing the whole pertussis component should not be given to children with an evolving neurological disease Live vaccines like BCG must not be given to immunosuppressed due to malignant disease (child with clinical disease), therapy with immunosuppressive agents or irradiation Absolute contraindications to immunizations are: Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindicated to vaccination; unless the child is so sick that he needs to be hospitalized Exclusive for the first 6 months of life  Complemented at 6 months, excluding milk supplements  Extend breastfeeding up to 2 years and beyond Vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or years 1 year above – 95% protection 9 months – 85% protection

 

Key messages on IYCF   Initiate breastfeeding within 1 hour after birth

Safe and effective with mild side effects after vaccination. Local reaction, fever and systemic symptoms can result as part of the normal immune response  Giving doses of vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccines leads to higher antibody levels


 

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A child is said to be “Fully Immunized Child” (FIC) when a child receives 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and 1 dose of measles before a child’s 1st birthday Tetanus Toxoid Immunization Schedule for Women EPI vaccines and characteristics

    

Occupational Health Program Health Development Program for Older Persons (Elderly Health) Persons with Disabilities Program Prevention of Blindness Program Rabies Control Program Safe Motherhood and Women's Health Schistosomiasis Control Program Smoking Cessation Program Soil Transmitted Helmenthiasis TB Control Program

 

OTHER HEALTH PROGRAMS                              Adolescent and Youth Health and Development Program Botika Ng Barangay Breastfeeding Program / Mother and Baby Friendly Hospital Initiative Blood Donation Program Child Health Diabetes Mellitus Prevention Program Dengue Control Program Dental Health Program Doctors to the Barrios (DttB) Program

   

LAWS AFFECTING PUBLIC HEALTH REPUBLIC ACT

Republic Act 9288 - Newborn Screening –


Emerging Disease Control Program Environmental Health Expanded Program on Immunization

An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening

Republic Act 9165 - Dangerous Drugs Act of 2002 -


Family Planning Food and Waterborne Diseases Prevention and Control Program Food Fortification Program FOURmula One Garantisadong Pambata GMA 50 / Parallel Drug Importation (PDI) Healthy Lifestyle Program Knock-Out Tigdas Leprosy Control Program Malaria Control Program Measles Elimination Campaign (Ligtas Tigdas) National Cardiovascular Disease Prevention and Control Program National Filariasis Elimination Program  National Mental Health Program Natural Family Planning Newborn Screening Nutrition   

An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes

Republic Act 9257 - Expanded Senior Citizens Act of 2003

An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes"

Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995


An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes.

Republic Act 6675 - Generics Act of 1988

An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names

Republic Act 4226 - Hospital Licensure Act

An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency

Republic Act 3573

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Declared that all communicable diseases should be reportes to the nearest health station

Republic Act 7305  Magna Carta for Public Health Workers Aims to promote and improve the social and economic well-being of health workers

Republic Act 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 Penal Ties For Violation Thereof EXECUTIVE ORDER  An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose

Republic Act 7875 - National Health Insurance Act of 1995

Executive Order No. 663

Republic Act 8504 - Prevention and Control of 1988

Implementing the the National Commitment for "Bakuna ang Una Sa Sanggol At Ina", Attaining World Health Organization's goals to Eliminate Measles and Neonatal Tetanus, Eradicate Polio, Control Hepatitis B and Other Vaccine-Preventable Diseases

Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The Philippine National Aids Council, And For Other Purposes

Executive Order No. 102


Redirecting the Functions Department of Health.

and

Operations

of

the

Executive Order No. 51

Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997)

An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes

Adopting a National Code of Marketing of Breastmilk Supplements and related products, penalizing violations thereof, and for other purposes.

Executive Order No. 472

Transferring the National Nutrition Council from the Department of Agriculture to the Department of Health

Republic Act 8749 - Philippine Clean Air Act of 1999

PRESIDENTIAL DECREE  Presidential Decree No. 856  Code on Sanitation of the Philippines


An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes

Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments

Presidential Decree No. 522  Prescribing Sanitation Requirements for the Operation of Establishments and Facilities for the Protection and Convenience of the Travelling Public

An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases 

Republic Act 5921  An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes

Presidential Decree No. 651  Requiring the Registration of Births and Deaths in the Philippines which occurred from January 1, 1974 and thereafter

Republic Act 8976

Presidential Decree No. 996


Philippine Food Fortification Act of 2000


Providing for Compulsory Basic Immunization for Infants and children below eight years of age

Republic Act 6713  Code of conduct and Ethical Standards for Public Officials and Employees

Presidential Decree No. 965

Republic Act 7160  Responsibility for the delivery of basic services and facilities of the national government has been transferred to the local government 

A Decree Requiring Applicant for Marriage License to Receive Instructions on Family Planning and Responsible Parenthood

Presidential Decree No. 384

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Amending Republic Act Numbered 4073, entitled an An Act Further Liberalizing the Treatment of Leprosy by Amending and Repealing certain Sections of the Revised Administrative Code

for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes" Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995 An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes. Republic Act 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency Republic Act No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305) Republic Act 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 Penal Ties For Violation Thereof Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose Republic Act 7432 - Senior Citizen Act of 1992) An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Amendment to RA 7170 - Organ Donation Act of 1991 An Act To Advance Corneal Transplantation In The Philippines, Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991 Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997) An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes

Presidential Decree No. 893

Reconstituting the National Schistosomiasis Control Commission into the Schistosomiasis Control Council and for other Purposes

Presidential Decree • • • • • • • • • • • • •
Presidential Decree 881 January 30, 1976 Empowering the Secretary of Health to regulate the labeling, sale and distribution of hazardous substances Presidential Decree No. 856 Code on Sanitation of the Philippines (with Implementing Rules and Regulations) Presidential Decree No. 522 Prescribing Sanitation Requirements for the Operation of Establishments and Facilities for the Protection and Convenience of the Travelling Public Presidential Decree No. 651 Requiring the Registration of Births and Deaths in the Philippines which occured from January 1, 1974 and thereafter Presidential Decree No. 996 Providing for Compulsory Basic Immunization for Infants and children below eight years of age Presidential Decree No. 498 Amending sections two, three, four, seven, eight, eleven, thirteen, sixteen, seventeen, twenty-one and twenty-nine of Republic Act No. 5527, also known as the Philippine Medical Technology Act of 1969 Presidential Decree No. 965 A Decree Requiring Applicant for Marriage License to Receive Instructions on Family Planning and Responsible Parenthood Presidential Decree No. 1631 Creating the Lunsod ng Kabataan Presidential Decree No. 1823 Creating the Lung Center of the Philippines Presidential Decree No. 384 Amending Republic Act Numbered 4073, entitled an An Act Further LIberalizing the Treatment of Leprosy by Amending and Repealing certain Sections of the REvised Administrative Code Presidential Decree No. 1832 Creating National Kidney Foundation of the Philippines Presidential Decree No. 893 Reconstituting the National Schistosomiasis Control Commission into the Schistosomiasis Control Council and for other Purposes Presidential Decree No. 79 Revising the Population Act of Nineteen Hundred and Seventy-one

Republic Act
Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening Republic Act 9165 - Dangerous Drugs Act of 2002 - An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending

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Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes Republic Act 7394 The Consumer Act Of The Philippines Republic Act 8976 Philippine Food Fortification Act of 2000 Republic Act 4688 - An Act Regulating the Operation and Maintenance of Clinical Laboratories and Requiring the Registration of the same with the Department of Health, Providing Penalty for the Violation thereof, and for Other Purposes Republic Act Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening Republic Act 9165 - Dangerous Drugs Act of 2002 - An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes" Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995 An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes. Republic Act 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency Republic Act No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges

Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305) Republic Act 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 Penal Ties For Violation Thereof Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose Republic Act 7432 - Senior Citizen Act of 1992) An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Amendment to RA 7170 - Organ Donation Act of 1991 An Act To Advance Corneal Transplantation In The Philippines, Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991 Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997) An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes Republic Act 7394 The Consumer Act Of The Philippines Republic Act 8976 Philippine Food Fortification Act of 2000 Republic Act 4688 - An Act Regulating the Operation and Maintenance of Clinical Laboratories and Requiring the Registration of the same with the Department of Health, Providing Penalty for the Violation thereof, and for Other Purposes Republic Act Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening Republic Act 9165 - Dangerous Drugs Act of 2002 - An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes

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Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes" Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995 An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes. Republic Act 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency Republic Act No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305) Republic Act 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 Penal Ties For Violation Thereof Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose Republic Act 7432 - Senior Citizen Act of 1992) An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Amendment to RA 7170 - Organ Donation Act of 1991 An Act To Advance Corneal Transplantation In The Philippines, Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991 Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997) An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes

Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes Republic Act 7394 The Consumer Act Of The Philippines Republic Act 8976 Philippine Food Fortification Act of 2000 Republic Act 4688 - An Act Regulating the Operation and Maintenance of Clinical Laboratories and Requiring the Registration of the same with the Department of Health, Providing Penalty for the Violation thereof, and for Other Purposes Executive Order 102 MALACAÑANG MANILA BY THE PRESIDENT OF THE PHILIPPINES EXECUTIVE ORDER NO. 102 REDIRECTING THE FUNCTIONS AND OPERATIONS OF THE DEPARTMENT OF HEALTH WHEREAS, the Department of Health, hereafter referred to as DOH, has been transformed from being the sole provider of health services, to being a provider of specific health services and technical assistance provider for health, as a result of the devolution of basic services to local government units; WHEREAS, the DOH seeks to serve as the national technical authority on health, one that will ensure the highest achievable standards of quality health care, health promotion and health protection, from which local governments units, non-government organizations, other private organizations and individual members of civil society will anchor their health programs and strategies; WHEREAS, to effectively fulfill its refocused mandate, the DOH is required to undergo changes in roles,: functions, organizational processes, corporate values, skills technology and structures; WHEREAS, Section 20, Chapter 7, Title I Book III of Executive Order No. 292 series of 1987, otherwise known as the Administrative Code of 1987, empowers the President of the Philippines to exercise such powers and functions as are vested in him under the law: WHEREAS, Section 78 of the General Provisions of RA 8522, otherwise known as the General Appropriations Act of 1998, empowers the President to direct changes in organization and key positions of any department, bureau or agency; WHEREAS, Section 80 of the same General Provisions directs heads of departments, bureaus and agencies to scale down, phase out or abolish activities no longer essential in the delivery of health services; NOW, THEREFORE, I, JOSEPH EJERCITO ESTRADA, President of the Republic of the Philippines, by virtue of the powers vested in me by law, do hereby order the following: SECTION 1. Mandate. Consistent with the provisions of the Administrative Code of 1987 and RA 7160 (the Local Government Code), the DOH is hereby mandated to provide assistance to local government units (LGUs), people's organization (PO) and

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other members of civic society in effectively implementing programs, projects and services that will: a) promote the health and well-being of every Filipino; b) prevent and control diseases among populations at risks; c) protect individuals, families and communities exposed to hazards and risks that could affect their health; and d) treat, manage and rehabilitate individuals affected by disease and disability. SECTION 2. Roles. To fulfill its responsibilities under this mandate, the DOH shall serve as the: a) lead agency in articulating national objectives for health to guide the development of local health systems, programs and services; b) direct service provider for specific programs that affect large segments of the population, such as tuberculosis, malaria, schistosomiasis, HIV-AIDS and other emerging infections, and micronutrient deficiencies; c) lead agency in health emergency response services, including referral and networking systems for trauma, injuries and catastrophic events; d) technical authority in disease control and prevention; e) lead agency in ensuring equity, access and quality of health care services through policy formulation, standards development and regulations; f) technical oversight agency in charge of monitoring and evaluating the implementation of health programs, projects, research, training and services; g) administrator of selected health facilities at sub national levels that act as referral centers for local health systems i.e. tertiary and special hospitals, reference laboratories, training centers, centers for health promotion; centers for disease control and prevention, regulatory offices among others; h) innovator of new strategies for responding to emerging health needs; i) advocate for health promotion and healthy life styles for the general population; j) capacity-builder of local government units, the private sector, non-government organizations, people's organizations, national government agencies, in implementing health programs and services through technical collaborations, logistical support, provision of grant and allocations and other partnership mechanisms; k) lead agency in health and medical research; l) facilitator of the development of health industrial complex in partnership with the private sector to ensure self-sufficiency in the production of biologicals, vaccines and drugs and medicines; m) lead agency in health emergency preparedness and response; n) protector of standards of excellence in the training and education of health care providers at all levels of the health care system; and o) implementor of the National Health Insurance Law; providing administrative and technical leadership in health care financing. SECTION 3. Powers and Functions. To accomplish its mandate and roles the Department shall: a) Formulate national policies and standards for health; b) Prevent and control leading causes of health and disability; c) Develop disease surveillance and health information systems;

d) Maintain national health facilities and hospitals with modern and advanced capabilities to support local services; e) Promote health and well-being through public information and to provide the public with timely and relevant information on health risks and hazards; d) the resource allocation shift, specifying the effects of the streamlined set-up on the agency budgetary allocation and indicating where possible savings have been generated; f) Develop and implement strategies to achieve appropriate expenditure patterns in health as recommended by international agencies; g) Development of sub-national centers and facilities for health promotion. disease control and prevention, standards. regulations and technical assistance; h) Promote and maintain international linkages for technical collaboration; i) Create the environment for development of a health industrial complex; j) Assume leadership in health in times of emergencies, calamities and disasters; system fails; k) Ensure quality of training and health human resource development at all levels or the health care system; l) Oversee financing or the health sector and ensure equity and accessibility to health services; and m) Articulate the national hea1th research agenda and ensure the provision of sufficient resources and logistics to attain excellence in evidenced-based interventions for health. SECTION 4. Preparation of a Rationalization and Streamlining Plan In view of the functional and operational redirection in the DOH and to effect efficiency and effectiveness in its activities, the Department shall prepare a Rationalization and Streamlining Plan (RSP) which shall be the basis of the intended changes. The RSP Plan shall contain the following: a) the specific shift in policy directions. functions, programs and activities/ strategies; b) the structural and organizational shift stating the specific functions and activities by organizational unit and the relationship of each units; c) the staffing shift, highlighting and itemizing the existing filled and unfilled positions; and d) the resource allocation shift, specifying the effects of the streamlined set-up on the agency budgetary allocation and indicating where possible, savings have been generated. The RSP shall submitted to the, Department of Budget and Management for approval before the corresponding shifts shall be affected by the DOH Secretary. SECTION 5. Redeployment of Personnel. The redeployment of officials and other personnel on the basis of the approved RSP shall not result in diminution in rank and compensation of existing personnel. It shall take into account all pertinent Civil Service laws and rules. SECTION 6. Funding. The financial resources needed to implement the Rationalization and Streamlining Plan shall be taken from funds available in the DOH, provided that the total requirements for the implementation of the revised staffing pattern shall not exceed available funds for Personnel Services. SECTION 7. Separation Benefits. Personnel who opt to be separated from the service as a consequence of the implementation of this Executive Order shall be entitled to the benefits under existing laws. In the case of those who are not covered by existing laws, they shall be entitled to separation benefits equivalent to one month basic salary for every year of service or proportionate share thereof in addition to the terminal fee benefits to which he/she is entitled under existing laws, SECTION 8. Implementing Authority. Following the approved RSP, the DOH Secretary, in addition to his authority to implement the RSP is hereby authorized to determine the type of agencies and facilities necessary to carry out the Department's mandate and roles,

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including the pilot testing of programs and such-pre corporization of hospitals following strictly the principles of efficiency and effectiveness. SECTION 9. Effectivity. This Executive Order shall take effect immediately

i.

Disease surveillance 1. 2. Measure the magnitude of the problem Measure the effect of the control program

DONE in the City of Manila this 24th day of May in the year of Our Lord, Nineteen Hundred and Ninety-Nine.

By the President: OVERVIEW OF THE PUBLIC HEALTH NURSING RONALDO B. ZAMORA Executive Secretary THE PUBLIC HEALTH NURSE

Public Health Nursing and Community Health Nursing often used interchangeably

Qualifications and Functions Must be professionally qualified and licensed to practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA 9173) I. Management function a. b. II. Inherent in the practice of PHN Organizes the nursing service of the local health agency

PHN defined by WHO: “Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of total public health programme for the promotion of health, improvement of the conditions in the social and physical environment, rehabilitation of illness and disability”

CHN defined by Freeman: “Service rendered by a professional nurse with communities, groups, families and individuals at home, in health centers, in clinics, in schools and in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation”

Supervisory function a. Supervisor of the midwives and other health workers

III.

Nursing care function a. b. c. Inherent function of the nurse Based on the science of art and caring Caring for all levels of clientele toward health promotion and disease prevention

CHN defined by Jacobson “Nursing practice in a wide variety of community services and consumer advocate areas and in a variety of roles at times including independent practice… community nursing is certainly not confined to public health nursing agencies”

IV.

Collaborating and coordinating function a. b. Care coordinators for communities and their members Establishes linkages and collaborative relationships with other health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems

The original thrust of Public Health Nursing: “Nursing for the health of the entire public/community versus nursing only for the public who are poor”

Standards of Public Health Nursing: V. Health promotion and education function Public Health Nursing a. Activities goes beyond health teachings and health information campaigns • Refers to the practice of nursing in national and local government health departments and public schools It is a community health nursing practice in the public sector

VI.

Training function a. Initiates the formulation of staff development and training programs for midwives and other auxiliary workers •

VII.

Research function a. Participates in the conduct of research and utilizes research findings in her practice

Public Health Nurses • Refers to the nurses in the local/national health departments or public schools whether their official position title is public health nurse or nurse or school nurse

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PUBLIC HEALTH NURSES • • Leaders in providing quality health services to the communities First level of health workers to be knowledgeable about new public health technologies and methodologies Usually the first ones to be trained to implement new programs and apply new technologies

By Jhun Echipare

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