their development in the
COMMUNITY HEALTH NURSING MIDTERMS
PRIMARY HEALTH CARE APPROACH
I. Definition: PHC as a philosophy,
approach, structure and services.
II. Legal Basis of PHC in the
Philippines
III. Components of PHC
HEALTH PROMOTION
I. Concept of health promotion (as
embodied in the Ottawa Charter,
November 1986)
II. Health promotion strategies
a. Build healthy public policy
b. Create supportive environments
c. Strengthen community action
d. Develop personal skills
e. Reorient health services
III. Examples of theories/models of
health
- Pender, bandura
COMMUNITY ORGANIZING TOWARDS
COMMUNITY PARTICIPATION IN HEALTH
I. Definition of community
organizing
1. CO Characteristics
2. Process
3. Phases
4. Goal
PRIMARY HEALTH CARE
- Essential health care based
on practical, scientifically
sound and socially acceptable
methods and technology
made universally accessible
to individuals and families in
the community through their
full participation and at a cost
that the community and
country can afford to
maintain at every stage of
spirit of self-reliance and self-
determination.
ALMA ATA DECLARATION
- PHC was declared during the
first international conference
on Primary Health Care that
was held in Alma Ata, USSR on
Sep. 6-12, 1978, this was
sponsored by WHO and
UNICEF.
GOVERNMENT RESPONSE TO PHC
- LOI 949 – Adapted PHC on
October 19, 1979 signed by
Pres. Marcos with the goal of
“Health in the hands of the
people by the year 2020”
- This established a clear and
direct link between health
and development where it
acknowledges that a healthy
population is the moving
force for the economic
development of a community
who will enable the people to
enjoy sustained level of
health and wellness.
PRIMER ON THE PHC
- Goal: “health in the hands of
the people by the year 2020”
- Mission: To strengthen the
healthcare system by
increasing opportunities and
supporting the conditions
wherein people will manage
their own health care.
- Central Theme: Partnership
and empowerment towards
self-reliance.
- Core Strategy: Full
participation and active
 involvement of the
community towards the
development of self-reliance.
- Organizational Strategy –
Provides the framework for
meeting the goal of PHC
which is health for all which
calls for active and continuing
partnership among the
communities, private and
government agent which are
involved in health care.
LEGAL BASIS OF PHC
1. Universal Declaration of Human
Rights, ART. 25, SEC 1. Which states
that: “Everyone has the right to a
standard of living adequate for the
health and well-being of himself and
of his family, including the food,
clothing, housing and medical care
and necessary social services and the
right to security in the event of
unemployment, sickness, disability,
old age, widowhood, or lack of
livelihood.
2. Phil. Constitution of 1987, Art, XIII,
Sec 11, states that: “ the state shall
adopt an integrated and
comprehensive approach to health
development which shall endeavor
to make essential goods, health and
services available to all people at
affordable cost. There shall be
priority for the needs of the
underprivileged sick, elderly,
disabled, women, and children. The
state shall endeavor to provide free
medical services to paupers.
3. WHO (1995) believes that
“governments have a responsibility
for the health of their people which
can be fulfilled only by the provision
of adequate health and social
measures.
ESSENTIAL REQUISITES TO PHC
FOUR DIMENSIONS
1. Focus – From illness and cure to
health, prevention and care.
- Level of Prevention:
Promotion, Preventive,
Restorative
2. Content – From treatment and
episodes of specific problems to
health promotion and continuous
and comprehensive care.
3. Organization – From specialists,
physicians and single handed
practice to generalist practitioners,
other health care professionals and
teams.
4. Responsibility – From health sector
professional dominate with passive
reception to intersectoral
collaboration with the community
participation and self-responsibility
CHARACTERISTICS OF PHC AS A
STRATEGY
- Essential health care services
accessible and acceptable to
the community.
- Partnership between and
among health workers.
- Provision of health services at
the district level.
- Top-down decision making –
the more conventional
program associated with
disease prevention efforts.
a. It begins by seeking to
involve particular groups
or individuals in issues
and activities largely
defined by health
agencies, and regards
 improvement in
particular behaviors as
the important health
outcome.
ESSENTIAL SERVICES OF PHC
1. E – Education for Health
2. L – Local Endemic disease prevention
and control
3. E – EPI (Expanded Program on
Immunization)
4. M – MCN / Family Planning
5. E – Essential Drugs Provision /Herbal
Meds
6. N – Nutrition
7. T – Treatment of Communicable
diseases.
8. S – Safe Water and Sanitation
9. H – hospital as a center for wellness
10. O - Oral and dental Health
11. M – Mental Health
12. E – Elderly Care
3 MAJOR ASPECTS OF PHC ELEMENTS
1. Promotive Aspect – Includes
education concerning health
problems and the methods of
preventing them; promotion of food
supply and proper nutrition;
adequate supply of safe water and
basic sanitation
2. Preventive Aspect – Includes
maternal and child health care,
including family planning,
immunization against major
infectious diseases and prevention
and control of locally endemic
diseases.
3. Curative Aspect – Includes
appropriate treatment of common
diseases and injuries and the
provision of essential drugs.
4 CORNERSTONE/PILLARS OF PHC
1. Support mechanism made available
2. Active Community Participation
3. Intra and Inter sectoral linkages
4. Use of appropriate technology
CHARACTERISTICS OF PHC ELEMENTS
1. Community bases
2. Accessible
3. Acceptable
4. Sustainable
5. Affordable
OBSTACLES TO PCH NURSING
1. Role complexity – The CHN is
mandated to perform a lot of
functions with its inherent
responsibilities which require the
provision of a high level of nursing
care. The nurse needs to be skillful in
both technical and communication
skills.
2. Special Responsibilities – Despite the
recognition of the value of illness
prevention and health.
3. Role Confusion – Nurses, regardless
of whether they work in the
community or in hospitals, face
challenges disciplines. Difficulties can
emerge over role boundaries and
over the care provided by the team.
4. Lack of skills and training – There is a
need to change nurses’ attitudes to
enable them to work better with
groups in the community, with other
professionals on the health care
team and with members of the
society at large.
HEALTH PROMOTION
- The process of enabling
people to increase control
over, and to improve their
health. To reach a state of
 complete physical, mental
and social well-being, an
individual or group must be
able to identify and to realize
aspirations, to satisfy needs,
and to change or cope with
the environment.
OTTAWA CHARTER
1. Health – Is a resources for everyday
life; a positive concept emphasizing
social and personal resources, as well
as physical capacities.
- Therefore health promotion
is not just the responsibility of
the health sector, but goes
beyond healthy life – styles to
well-being (First International
Conference on Health
Promotion, Ottawa, Nov.
1986)
2. Health promotion – Occurs through
processes of enabling people;
advocacy, and by mediating among
sectors.
3. Health promotion action – Involves
helping people to develop personal
skills, creating supportive
environments, strengthening
communities, influencing
government.
OTTAWA CHARTER’S HEALTH PROMOTION
STRATEGIES
1. Build healthy public policy – Healthy
public policy is embodied in formal
statements that demonstrate
concern for healthy and equity and
which make healthy choices present
easier for citizens, through creating
supposed social and physical
environments that enables people to
lead healthy lives. (WHO)
2. Create a supportive environment –
The interrelationship between
people and environment based on
the socio-ecological approach to
healthy activities aimed at
establishing.
3. Strengthen Community Action – This
can be done through the
empowerment of the communities
so that they may have ownership and
control over their physical, social,
political and economic resources and
endeavors. This can be achieved
through community
development/action which is the
process of colletive community
efforts directed towards increasing
community control over the
determinants of health, improving
health and becoming empowered to
apply individual and collective skills
to address health priorities and meet
respective health needs (WHO,1998)
4. Develop personal skills – Personal
and social development can be
attained through health education,
enhancing social and life skills and
preparing people to cope with the
crises and challenges of life. Health
education has been defined as
“consciously constructed
opportunities for learning designed
to facilitate changes in behavior
towards predetermined goal and
involving some form of
communication designed to improve
health literacy, knowledge and life
skills conducive to individual and
community health.
5. Re-orient health services – The
responsibility for health promotion
and prevention of illness in health
services is a shared endeavor among
the different sectors of society and
 the community as a whole. The miscarriages, no regular
adoption of healthy options for a check up
healthy life should be the focus of EXAMPLES
attention not only by individuals and -Illness states , diagnose or
communities but also the different undiagnosed
components which affect OLOF like - Failure to thrive /develop
social, political, economic and - Disability
physical environment. 4. Foreseeable Crisis

CORE HEALTH PROMOTION STRATEGIES SECOND LEVEL (TYPOLOGY)

1. Health awareness – Raising 4 CRITERIA
awareness or consciousness of 1. Nature of the Problem
health issues
A. Methods – Health education talks,
group work, mass media, displays
and exhibitions, campaigns.
B. Actions – Encourage people to seek
early detection and treatment.

SESSION 2
FIRST LEVEL
1. Wellness
2. Health Threat
- Conditions that are conducive
to disease, accident or failure
to realize one’s potential.
EXAMPLES
- Family history or hereditary
disease
- Threat of cross infection
- Accident hazards
- Faulty eating habits
- Poor environmental
sanitation
- Unhealthy lifestyle/personal
habits
3. Health Deficit
- A gap between actual and
achievable health status.
- Instances of failure in health
maintenance
- Possible precursors: History
of repeated infections or