Primary Health Care sickness, disability, old age, widowhood, or lack

of livelihood.”
“Is essential health care based on practical,
scientifically sound and socially accyeptable Philippine Constitution of 1987, Art XIII, Sec 11
methods and technology made universally
“The state shall adopt an integrated and
acceptable to individuals and families in the
comprehensive approach to health
community through their full participation at a
development which shall endeavor to make
cost that the community and country can afford
essential goods, health and other social services
to maintain at every stage of their development
available to people at affordable cost. There
in the spirit of self-reliance and self-
shall be a priority for the needs of the
determination.”
underprivileged sick, elderly, disabled, women,
 Community members are expected to take and children. The State shall endeavor to
an active role in managing their own health provide free medical services to paupers.”
requirements, instead of depending on the
WHO (1995)
government.
 Gives importance to the participation of “Governments have a responsibility for the
various sectors of government and the health of their people which can be fulfilled only
private sector in local health services. by the provisions of adequate health and social
measures.”
Primary Health Care (PHC) was declared during
the: KEY PRINCIPLES

 First International Conference on Primary (Elements of Primary Healthcare)

Health Care held in Alma Ata, Russia
4As
 on Sept 6-12, 1978
 by the World Health Organization (WHO). 1. Accessibility
 The goal was “Health for All by the Year 2. Affordability
2000”. 3. Acceptability
4. Availability
Main objectives:
Support mechanisms
1. Promotion of healthy lifestyles
2. Prevention of diseases 1. People
3. Therapy for existing conditions 2. Government
3. Private sectors – NGOs, socio-civic and
Legal basis
faith groups
Universal Declaration of Human Rights, Art. 25,
Multisectoral approach
Section 1
1. Intrasectoral linkages – within the
“Everyone has the right to a standard of living
health sector: members of health team
adequate for the health and well-being of
and health agencies
himself and of his family, including food,
Ex: Two-way referral
clothing, housing and medical care and
2. Intersectoral linkages – between the
necessary social services and the right to
health sector and other sectors of
security in the event of unemployment,
society
 Ex: Rabies Prevention & Control
Program: DOH, DA, DepEd and LGUs
Community participation
 An educational and empowering process in
which people identify the problems and
increasingly assume responsibilities
themselves to plan, manage, control, and
assess the collective actions that are proved
necessary
Equitable distribution of health resources
Ex: manpower to rural areas
1. Doctor to the Barrios (DTTBB) Program
2. Registered Nurse Health Enhancement
and Local Service (RNHeals)
3. Nurse Deployment Project (NDP)
Appropriate technology
RA 8423 – Traditional and Alternative Medicine
Act
Ex:
Obstacles to Primary Health Care Nursing
1. Role complexity – nurse needs to be skillful
in both technical and communication skills
2. Special responsibilities – focus on
individuals and families to solve specific
health problems
3. Role confusion – nurse needs to be flexible
4. Lack of skills training – there is a need to
change nurses’ attitude to enable them to
work better with groups in the community
with other professionals on the health care
team and society
Governments Response to PHC
PHC was adopted in the Philippines through
Letter of Instruction 949 signed by President
Marcos on October 19, 1979 and has an
underlying theme of “Health in the Hands of the
People by 2020.”
The introduction of PHC begun in 1979 by pilot
testing the methodology in one province in each
of the 12 regions.

 Lagundi (Decoction) – asthma, cough, Levels of Healthcare

scabies Philippines
 Acupressure
 Refloxology  There are 81 provinces at present, further
subdivided into component cities and
ESSENTIAL HEALTH SERVICES municipalities.
E – education for health  As of May 2019, there were 42, 025
barangays
L – locally endemic disease control
Leyte
E – expanded program for immunization
 It has 6 provinces: Biliran, Eastern Samar,
M – maternal and child health including Leyte, Northern Samar, Southern Leyte, and
responsible parenthood Samar
E – essential drugs  7 cities: Tacloban (Highly Urbanized City) as
the regional capital, Borongan, Baybay,
N – nutrition Ormoc, Maasin, Calbayog, and Catbalogan;
136 municipalities and 4,0390 barangays
T – treatment of communicable and
noncommunicable diseases

S – safe water and sanitation

  Ensures constituents’ access to secondary
and tertiary care through vertical referrals

City governments – responsible for city health

offices, city hospitals in HUCs (except NCR) and
corresponding RHUs and BHSs

Barangay governments – responsible for the

maintenance of RHU AND BHS facilities

Classification of Hospitals

According to functional capacity:

Bring basic services closer to people, less
fragmentation and more segregation delegation
of public health services into the LGUs, made
possible by Local Government Code RA 7160
(1991)
a. General Hospital
Provides medical and surgical care to the
sick and injured and maternity care and
shall have as minimum, the following
services: medicine, pediatrics, obstetrics
and gynecology, surgery and anesthesia,
emergency services, out-patient and
ancillary services.
b. Specialty Hospital
Specializes in a particular disease or
condition or in one type of patient.

Provincial governments – responsible for New classification

medical, hospital, and support services of Hospitals Other health
provincial and district hospitals facilities
 Carigara District Hospital, Ormoc District General A. Primary Care
 Level 1 Facility
Hospital, Leyte Provincial Hospital
 Level 2 B. Custodial Care
Municipal governments – administration of  Level 3 Facility
primary health care and other national (Teaching/Training C. Diagnostic
programs’ field services through the municipal ) Facility
health offices and corresponding RHUs and Specialty D. Specialized
BHSs Out-Patient
Facility
 Health promotion

“Health promotion is about enabling and

empowering people, communities and
societies to take charge of their own health
and quality of life.” (WHO, 2016)

The Ottawa Charter for Health Promotion

First International Conference on Health Promotion,
Ottawa, 21 November 186

 Health is seen as a resource for everyday

life, not the objective of leaving.
 Health promotion is not just the
responsibility of the health sector, but
goes beyond healthy lifestyles to well-
being.

Ottawa Charter’s Strategies

1. Build healthy public policy

2. Create supportive environments
3. Strengthen community actions
4. Develop personal skills
5. Reorient health services
6. Moving into the future

(refer to the book, waray daw niya ibutang

tanan ha ppt)
Levels of Health Care Facilities

1. Primary – includes rural health units, sub-

centers, community hospitals, specialty
clinics and/or health centers operated by
both government and private entities, non-
government agencies and other groups
2. Secondary – includes smaller, often non-
departmentalized hospitals that offer a
variety of healthcare services which
require moderately-specialized adequate Core Health Promotion Strategies
case management, includes provincial and 1. Health awareness
regional hospitals 2. Changing attitudes and behavior
3. Tertiary – includes health care facilities 3. Improving knowledge
that offer highly-technological and 4. Self-empowering
sophisticated healthcare services such as 5. Societal and environmental change
those offered by specialty national
hospitals and medical centers
 Theories of Health Promotion 2. Individuals in all their biopsychosocial
complexity interact with the environment,
Health Promotion Model by Nora Pender
progressively transforming the environment
Individual Behavior-specific Behavioral and being transformed over time
characteristics cognitions and outcomes 3. Health professionals constitute a part of the
affect interpersonal environment, which exerts
 Prior related  Perceived  Immediate influence on persons throughout their life span
behavior benefits of competing 4. Self-initiated reconfiguration of person-
 Personal actions demands environment interactive patterns is essential to
factors:  Perceived (low behavior change
biological, barriers to control)
psychologic actions and Health Belief Model
al,  Perceived preference
sociocultura (high  One of the first theories of health behavior.
self-efficacy
l  Activity- control)  HBM is a good model for addressing
related affect  Commitme problem behaviors that evoke health
 Interpersonal nt to a plan concerns (e. g., high-risk sexual behavior
influences: of action and the possibility of contracting HIV)
(family,  Health (Croyle RT, 2005)
peers, promoting
providers); behavior The HBM proposes that a person’s health-
norms related behavior depends on the person’s
support, perception of four critical areas:
models
1. The severity of a potential illness
 Situational
2. The person’s susceptibility to that illness
influences:
3. The benefits of taking a preventive action
options,
demand 4. The barriers to taking that action
characteristic There are six major concepts in HBM:
s, aesthetics
1. Perceived susceptibility
2. Perceived severity
The model notes that each person has unique personal
3. Perceived benefits
characteristics and experiences that affect subsequent
4. Perceived costs
actions.
5. Motivation
The set of variables for behavioral specific knowledge 6. Enabling or modifying factors
and affect have important motivational significance.
These variables can be modified through nursing
actions.

Health promoting behavior is the desired behavioral

outcome and is the end point in the HPM.

Assumptions of the HPM:

1. Individuals seek to actively regulate their own

behavior
  People think about the consequences and
implications of their actions, then decide
whether or not to do something.
 Therefore, intention must be highly
correlated with behavior.
 Whether, or not a person intends to
perform a health behavior should correlate
with whether or not they actually DO the
behavior

Components of the Model

The Trans-Theoretical Model and Stages of
1. Attitudes toward a specific action
Change by Prochaska, Nacross & Diclemente
 What will happen if I engage in this
 Model inspired by smoking cessation behavior?
studies  Is this outcome desirable or
 Draws on fields of psychotherapy and undesirable?
behaviour change 2. Subjective norms regarding that action
 Seeks to help us understand behavior  Normative beliefs: Other’s expectations
change  Motivation to comply: Do I want to do
 Model has been applied to a wide range of what they tell me? How much? Why?
health behaviours: addiction, bullying,  TRA works best when applied to behaviors
eating disorders, HIV/AIDS prevention, etc. that are under the person’s control (or they
think they are)
Model consists of four core constructs
 TPB works best when the behavior is not
1. Stages of Change (6 stages) perceived to be under the person’s control.
- Pre contemplate (the individual has
Social Learning Theory by Bandura
no intention to take action toward
behaviour change int the next 6
months
- Contemplation (way Pros and
Cons.)
- Preparation
- Action (the individual change; overt
behaviour)
- Maintenance Milio’s Framework of Prevention
2. Processes of Change (10 processes)
Nancy Milio a nurse and leader in public health
3. Decisional Balance (Pros/Cons)
policy and public health education developed a
4. Self-efficacy (Confidence/Temptation)
framework for prevention that includes
Theory of Reasoned Action and Theory of concepts of community-oriented, population
Planned Behavior by Fishbein and Ajzen focused care (1976, 1981)

 Human behavior is under the voluntary  Governmental and institutional

control of the individual policies set the range of options for
personal choice making.
  It neglected the role of community Enabling factors: refer to condition in people in
health nursing, examining the the environment that facilitate or impede
determinants of community health health.
and attempting to influence those
Reinforcing factors: refer to feedback given by
determinants through public
support persons or groups.
policy”
Tannahill Model of Health Promotion
General categories of nursing interventions:
 Health Education: communication
1. Education directed toward voluntary
activity aimed at enhancing well-being
change in the attitude and behaviour of
and preventing ill-health through
the subject.
favourably influencing the knowledge,
2. Engineering directed at managing risk-
beliefs, attitudes and behaviour of the
related variables
community.
3. Enforcement directed at mandatory
 Health Protection: refers to the policies
regulation to achieve better health
and codes of practice aimed at
Precede-Proceed Model preventing ill-health or positively
enhancing well-being, for example, no
 In this framework, health behaviours is
smoking in public places.
regarded as being influenced by both
 Prevention: refers to both the initial
individual and environmental factors,
occurrence of disease and also to the
and hence has two distinct parts.
progress and subsequently the final
 First is an “educational diagnosis” –
outcome.
PRECEDE
 Second is an “ecological diagnosis” – Leavell and Clark’s
PROCEED
Levels of Prevention

Primary Prevention

 Is general knowledge that is

applied in family assessment
and intervention for
identification and mitigation of
risk factors associated with
environmental stressors to
prevent possible reaction.
 Seeks to prevent a disease or
condition ar a prepathological
state.
 To encourage optimal health
Predisposing factors: Refer to people’s and to increase person’s
characteristic that motivate them toward health resistance to illness.
related behaviour  To stop something from ever
happening.
 Focus:
 o Specific Protection Focus:
o Health Promotion
 Prompt treatment
 Behaviors:
 Early detection/Diagnosis
o Quit smoking
Screening
o Avoid/limit alcohol
intake Example:
o Exercise regularly
1. Have annual physical
o Eat well-balanced diet
examination
o Wear hazard devices in
2. Regular Pap’s test for
work site
women
o Immunization
3. Monthly BSE for women
who are 20 years old and
Factors leading to renewed interest in health above
promotion 4. Sputum exam for
tuberculosis
1. Need for change in focus 5. Annual rectal examination
2. Rising cost for client’s over 50 years
3. Demystification of Primary health care old.
4. Consumerism and popular demands for
increased self-control Goal: Control the progression of the disease
5. Changes in life style and increased and prevent disability
Educational Levels Role of Nurse
6. Lack of accessible and available
professional health services  Screening through visual and auditory
7. Growing recognition of the testing of children
interrelationship between stress and  Completing of histories and physical
illness examinations of all family members
 Initiate and follow through on referral
for diagnosis and treatment
Secondary Prevention

Is symptomatology following reaction to

Tertiary Prevention is the adjustive processes
stressors, appropriate ranking of intervention,
taking place as reconstitution begins and
priorities, and treatment to reduce their
maintenance factors move the client back in a
noxious effects.
circular manner toward primary prevention.
Also known as health maintenance.
 Post pathologic state
Seeks to identify specific illness or  To support the client’s achievement of
conditions at an early stage with prompt successful to known risks, optimal
intervention to prevent or limit disability. reconstitution, and/or establishment of
high-level wellness
To prevent catastrophic effects that
 Occurs after a disease or a disability has
could occur if proper attention and treatment
occurred and the recovery process has
are not provided.
begun.
  Intent is to halt the diseases or injury
process and assist the person in
obtaining an optimal health status
Focus:
 Rehabilitation
 Minimize client’s disability
 Maximize his level of functioning
Example:
1. Self-monitoring of blood glucose among
diabetics
2. Physical therapy after CVA
3. Participation in Cardiac Rehabilitation
after MI
4. Attending self-management education
for diabetes
5. Undergoing speech therapy after
laryngectomy
Role of Nurse:
 Direct care-giving, team member,
coordinator, patient/family advocate,
teacher, counsellor and environmental
modifier
Health teaching in home safety.
Secondary health problem: Fall
The Major Thrust of Family Nursing: Health
Promotion
Primary Prevention is included under the health
promotion as one of its important components.
The “NEW MEDICINE” or alternative health care
(holistic care, self-care and wellness training) is
fundamental belief of taking responsibility of
one’ s health.
Ex. Yoga, meditation, biofeedback, acupressure,
acupuncture, guided imagery, visualization,
body therapies.
Specialized Fields of Community Health
Nursing
School Health Nursing
Is the application of nursing
theories and principles in the care of
the school population
Components of School Health Nursing
1. School Health Services – maintain
school clinic, screening of all
children.
2. Health Instruction – as health
educator/counsellor
3. Health monitoring
a. Mental Health – substance
abuse, sexual health
b. Environmental health – food
sanitation, water supply, safe
environment, safe toilet
c. School community linkage – as
community
Aims of the program
 - To promote the health of school 5. Conduct and participates in researches
children and prevent health related nursing care.
problems that would hinder the 6. Establish/strengthen linkages with
learning process and performance government and non-government
of their developmental task. Health organization/agencies for school
is considered an important requisite community health work.
for education.
Duties and Responsibilities of School Nurses
The Health and Nutrition Center (HNC_ under
1. Health advocacy and health education
the Department of Education has the
2. Health and nutrition assessment
responsibility to safeguard the health and
3. Supervision of the health and safety of
nutritional well-being of the total school
the school
population.
4. Treatment of common ailments and
Divisions: attending to emergency cases
5. Referrals and follow-ups of pupils and
a. Nutrition Division
personnel
b. Health Division: Medical, Dental,
6. Home visits
Nursing and Health Education Sections
7. Community outreach
Determinant of School Health Nursing (Factors) 8. Recording and reporting of
accomplishments
1. Characteristics of clientele 9. Monitoring and evaluation of programs
2. Policies of the Department of Education and projects
3. Program of the Department of Health
4. Standard of the Nursing Profession Functions of School Nurse

Objectives of School Health Nursing 1. School Health and Nutrition Survey

a. Current health and nutritional
General Objective: To promote and maintain status of children
the health of the school populace by providing b. Status of health facilities
comprehensive and quality nursing care. c. Actual status of health
Specific Objective: education activities being
undertaken by teachers and
1. Provide quality nursing service to the health personnel
school populace. 2. Putting up a Functional School Clinic –
2. Create awareness among school for treatment of minor ailments and
children, personnel and administrators attendance to emergency cases as
on the importance of the promotive mandated by RA 124
and preventive aspects of health
through health education.
3. Encourage the provision of standard
functional facilities.
4. Provide nursing personnel with
opportunities for continuing education
and training.
 c. Disseminating relevant finding on
health promotion and nutrition-
related facts
11. Organization of School – Community
Health and Nutrition and Nutrition
Councils – school and members of the
community are its members.
12. Communicable Disease Control – a join
responsibility of the school, parents,
students and DepEd
3. Standard Vision Testing for School
a. Checks the immunization status of
Children and referring child with 20/40
the child and encourages
visual acuity or poorer to an eye
compliance
specialist. Parents should be informed
b. Aids in early detection
ASAP.
c. Helps to provide parental
4. Health Assessment
notification and information
a. Interviewing
13. Establishment of Data Bank on School
b. Thorough PE
Health and Nutrition Activities
c. Vital signs
An accurate and updated school health
d. Visual acuity/hearing test
records should contain the following:
e. Appraisal of general physical mental
a. Treatments in the school clinic
condition
b. Records of school visits (RHU and
f. Recording of findings
School health personnel)
5. Ear examination – primary concern is to
c. Health Assessment report of the
detect hearing difficulties or disorders
school health personnel
as early as possible
d. Health and nutritional status of the
6. Height and Weight Measurement and
students/pupils
Nutritional Status Determination
e. Form 86 of teaching and non-
a. Weight-for-age; height-for-age
teaching personnel
(below 10 years old)
f. Teachers’ health profile
b. BMI (>10 yrs) – beginning and end
g. Records of emergency cases
of SY
attended to
7. Medical Referrals
h. Records of referral made
8. Attendance to Emergency Cases
i. Inventory of clinic equipment and
9. Student Health Counselling – esp on
supplies
matters of emotional and physical
j. Health and nutrition activities in
problems
school
10. Health and Nutrition Education
k. Records of accomplishments of
Activities – formal and informal settings
school health service
by:
l. Records of officer/officials of the
a. Planning and conducting training
school-community health council
programs, seminars, workshops on
and their accomplishments
health-related topics
m. Action plan
b. Acting as a resource person on
n. Performance contract
health-related activities
 14. School plant inspection for health
environment
15. Rapid school inspection – routine
procedure and immediate after holidays
and between health assessments; not
be more than 1x/month except in cases
of epidemics
a. Detect cases of communicable
diseases
b. Note the corrections that have been
made
c. Note if eyeglasses used by the
students are correctly adjusted
d. Note the general cleanliness of the
pupils
e. Note new ailments
Legal Bases of the School Health Program
1. PD 603 Child and Youth Welfare Code
Article I – General Principles – The child
is the most important asset of
a nation
Article II – Promotion of Health – It
should be the responsibility of
the health, welfare and
education entities to assist the
parent in looking after the
health of the child
Article III – The Rights of the Child –
Every child has the right to a
balanced diet, adequate
clothing, sufficient shelter,
proper medical attention, and
the basic physical
requirements of a healthy and
vigorous life
2. 1986 Constitution of the Philippines –
Art III Secs 11-13 on Social Justice and
Human Rights
3. Executive Order No. 14, s. 1946 –
creation of the Medical and Dental
Services granting authority for the
voluntary contribution of 50 centavos
per pupil for the maintenance of service
4. RA No. 951 s. 1947 – Medical Inspection
of school children enrolled in private
schools, colleges and universities in the
Philippines
5. RA No. 847 s. 1953 – Return of the
Medical and Dental services from the
DOH to DepEd
6. PD 491 s. 1974 – Nutrition Act of the
Philippines
7. RA No. 2620 s. 1961 – Nationalization
of the Medical and Dental Services of
the Bureau of Public Schools, DepEd
8. LOI No. 764 s. 1978 – declaring the
School Health Program, educating
teachers and school children in the use
of medicinal plants as simple remedies
for common ailments
9. LOI No. 441 s. 1976 – mandated the
integration of Nutrition Education in the
School curriculum
10. Sec. 938 of the Revised Administrative
Code – Bureau of Public Schools shall
have the specified powers regarding
health teaching and PE
11. EO No. 234 s. 1987 – reorganizing the
National Nutrition Council
Occupational Health Nursing
It is the application of Nursing principles
and procedures in conserving the health of
workers in all occupations.
Focus:
Promotion, protection and restoration
of worker’s health within the context of a safe
and healthy work environment.
Objectives/Goals:
By 2022, reduce the number of
occupational diseases and injuries by 30% from
the 2015 baseline as identifies in the
Occupational Health and Safety Profile of the
Philippines
Target Population/Client
- Informal Sector Workers (ISW)
consisting of Agricultural Workers,
Small-scale Miners, and Transport
Group
- Public Health Workers (PHW)
Policies and Laws
Strategies and Action Points
 1961, Administrative Order No. 63
“Industrial Hygiene Code”
 1975, Presidential Decree No. 856
Code on Sanitation of the
Program Strategies/Key Result Areas
Philippines
 1987, Philippine Constitution of
1987 (Article II, Section 15)
 2008, Joint Administrative Order
between DTI-DENR-DA-DOF-DOH-
DILG-DOLE-DOTC No. 01 “The
Adoption and Implementation of
the Globally Harmonized Systems of
Classification and Labelling of
Chemical (GHS)
 2012, DOH Administrative Order
No. 2012-0020 “Guideline
Governing the Occupational Health
and Safety of Public Health Workers
 2013, DOH Administrative Order
No. 2013-0018 “National
Occupational Health Policy for the
Informal Mining, Transport and
Program Accomplishment status
Agricultural Sectors”
 2013, DOH Administrative Order
No. 2013 – 0009 “National Chemical
Safety Management and Toxicology
Policy
 2013, DOH Department Personnel
Order No. 2013-3584 "Designation
of Undersecretaries and Assistant
Secretaries as Heads of Technical
and Operations Cluster for
Kalusugang Pangkalahatan, the
Occupational Health and Safety
Committee for the Department of
Health and other Attached
Agencies" and its Reconstitution
DPO No. 2014-2282 and 2014-
2262-A "Reconstitution of the
Occupational Health and Safety
Committee for the Department of
Health and other Attached
Agencies"
- Environmental and Occupational
Health Strategic Plan 2017-2022
1. Establish/Institutionalize Regional
Occupational Toxicology (wherein
Mercury Surveillance is incorporated)
and Poison Control Center
2. Integration of Occupational Health
Services (OHS) as part of the Primary
Health Approach
3. Upgrade manpower capability of health
personnel and existing facilities
4. Preventive and promotive occupational
health strategies
5. Toxicovigilance activities
6. Advocacy campaign through the
“Health Workplace” initiative
7. Research
8. Multi-agency linkages
- Framework on the National
Program on Chemical Safety
Management and National Action
Plan (2012) .
- National Action and
Implementation Plan for the
National Chemical Safety
Management Program (2013)
- Posting in DOH Website Emergency
Hotlines for Poisoning
Cases/Incidents
- Technical Assistance in the
establishment of Poison Control
and Information Centers in DOH-
retained and specialty hospitals (i.e.
East Avenue Medical Center, Rizal
Medical Center, Baguio General
Hospital and Medical Center,
Batangas Medical Center, Bicol
Medical Center, Corazon Locsin
Montelibano Memorial Regional
Hospital, Western Visayas
- Sanitarium, Eastern visayas
Regional Medical Center,
Zamboanga Medical Center,
Northern Mindanao Medical
Center, and Southern Philippines
Medical Center)