Primary Health Care Delivery System

A health system, also sometimes referred to as health care system or as healthcare

system, is the organization of people, institutions, and resources that deliver health care
services to meet the health needs of target populations.

Healthcare in Philippines. … All citizens are entitled to free healthcare under the
Philippine Health Insurance Corporation (PhilHealth). The scheme is government-controlled and
funded by local and national government subsidies, as well as by contributions from employers
and employees.

History of Primary Health Care

 1970: Community Based Health Program (CBHP)

- Start exploring new ways of answering the health needs of the people. (other
ways to solve malnutrition, leptospirosis, and other communicable diseases)
- Develop during Marcos Times (Martial Law), CBHP became accepted and
respected
 1975
- CBHP launched, this attempt to bring health education and services to the
barrios that had long been regulated by clinic and hospital oriented.
- Adopted by rural Missionaries of the Phil. – later with other religious organization
like National Council of Churches in the Philippines (NCCP and AKAP)

Background of Primary Health Care

 1981
 Implementation of PHC started, a lot of health programs were launched to
promote the principles of PHC.
 During the time of Aquino: program of PHC created
 In a post research/ action workshop on PCHD in June 1991 under Health
Secretary Mario Taguiwalo, refocusing was done for conceptualization of
Partnership with community Health Development.
 During the time of Ramos:
 Health Secretary Juan Flavier continued PCHD and implementation of the
Local Government Code of 1991 – transference of responsibility of
supervising the implementation of PHC from the national to LGU (bring
government closer to people thus DOH formally declared as “Health is in the
hands of the people” as the core strategy in the programs thrust of the
government.)
s RA 7160 (Devolution) – transference of the roles and responsibilities from
National to Local Government Unit
 1978
  A total of 150-member state of the WHO participated in the Alma Ata
conference in Russia.
 Declared that the main social target of government and WHO is the attainment
of a level of health that will permit people lead to a socially and
economically productive life. PHC as its core strategy in its health programs.
Primary Health Care
 (WHO) essential health care made universally accessible to individuals and families in
the community by means acceptance to them, through their full participation and at a
cost that the community and country can afford at every stage of development.
 Goal: health in the hands of the people that involves maximum participation in the
whole process.
 Mission: to strengthen the health care system by increasing opportunities and
supporting the conditions wherein people will manage their own health care.
 Concept:
 PHC includes the full participation and development of self-reliant people,
capable of achieving and acceptable level of health and well-being.
 It also recognizes the interrelationship between health and the over-all political,
socio-cultural and economic development of society.
 PHC organize in Alma Ata Conference in Russia dated September 6-12, 1978,
sponsored by the WHO and UNICEF.
 Legal Basis. Letter of Instruction No. 949, October 19, 1979 signed by
President Ferdinand E. Marcos with the goal of “Health in the hands of the people
by year 2000,” this establishes a clear and direct link between health and development
where it acknowledges that a healthy population is the moving force for the economic
development.
 Central Theme: Partnership and empowerment towards self-reliance
 Core Strategy: Community Full Participation (CFP) and Community Active
Involvement (CAI) of the entire community towards the development of self-reliance.
 Existing Policy: (Universal Declaration of Human Rights, Article 25, Section 1)
“Everyone has the right to a standard of living adequate for the health and well-being of
himself and of his family, including food, clothing, housing and medical care necessary
social services and the right to security in the event of unemployment, sickness,
disability, old, age, widowhood or lack of livelihood.
 Philippine Constitution of 1987, Article XIII, Section 11
 “State shall adopt an integrated and comprehensive approach to health and
other social services available to all the people at affordable cost.”

 WHO 1995
 Government have the responsibility for the health of their people which can be
fulfilled only by the provision of adequate health and social measures.”
 Concepts:
 Cooperation of the community: PHC represent a supplementary health
system that is extended from the system rendered by the state at the community
level with cooperation of the community.
 Capability of people to determine and analyze their own problem
cooperates in finding ways/ solution to their problem and acceptance
of their problems: PHC will equip the community with capability to solve its
own problem thru community participation and cooperates in organizing activities
to solve problem face by the community.
 Voluntary Community Involvement: it is the heart and soul of PHC
activities; community support may be in terms of labor, money or cooperation on
a voluntary basis.
 Basic minimum needs of the society should be spelled out: done to
provide opportunity for the underprivileged majority, to develop to an acceptable
level.
 Villagers work to ensure better living of the community: government
officials do not work in place of the villagers; villagers do not work for officials;
villagers work to ensure better living of the community. (work with the
community people)
 PHC to achieve better quality of life: PHC must be integrated with other
development activities aiming to achieve better quality of life which encompasses
satisfaction with various life circumstances such as health, income, standard of
living, work conditions, marriage, family and friends, neighborhoods system of
government and public safety and education.
 Self-Reliance: the community must take as its role and responsibility to
develop this self-reliance which means that the community can now manage its
own system and therefore can function independently. (leads to self-
empowerment)
Empowerment: is closely related to SR in a sense that people can now STAND
ALONE, they can provide themselves with the basic need requirements for
survival. (Being independent)
 PHC activities must be in harmony with existing institution and daily
life of the community: services should consider also the culture/ practices of
the people for it to be effective during the implementation phase. (partnership
between the people)
 PHC as an appropriate strategy: work should be feasible in its application for
problems solving appropriate to social conditions and problem being
encountered. (CHN Process – problem-solving scheme)
 PHC as a Public Health Services: PHC must be related to public health
services in such aspects as technical support, referral of patients for medical
 treatment provision of continuing education, provision of health information.
(Health teaching – primary responsibility)
Elements/ Fundamental Services of PHC
 Education for Health
 As health educator, we are not here to charge the behavior of the individual but
rather to motivate him thru information campaign for him to voluntary adapt to
those change as he interacts with the environment.
 Locally Endemic Disease Control
 Focuses on the prevention of the occurrences of endemic diseases because it is
continuously present in the community.
 Expanded Program on Immunization
 This exist to control the occurrences of preventable illnesses especially of
children (Measles, PTB, Poliomyelitis, DPT and Hepatitis)
 Maternal and Child Health
 Mother and child are the most delicate members of the community, therefore
protection of mother and child to illness and other risk would ensure a good
health for the community.
 Essential Drugs
 This focuses on the information campaign on the proper utilization and
acquisition of drugs. (Generic Act of the Philippines, 1988 also known as RA
6675)
 Nutrition
 Food is one of the basic needs of the individual; appropriate kind and
preparation of it can contribute to a healthy state, because of lack of knowledge
as well as faulty preparation so it leads to malnutrition – one of the major health
problems we have in our country.
 Treatment of Communicable Disease
 PTB, Malaria, Schistosomiasis and other CD associated with poverty continue to
be a serious problem with economic implication.
 Safe Water and Sanitation
 Access to potable water within 250 meters per 10-minute walk and sanitary toilet
is a must for every family

Principles:

1. Four (5) A’s: Accessible, Affordable, Attainable, Available and Acceptable

2. Partnership between the community and health agencies in the provision of quality basic
and essential health services.
 People should be the CENTER of DEVELOPMENT not as objects; participation
is always encouraged and that community needs and priorities should be the
basis for planning health services and activities.
3. Community Participation
  Considered as the core of the community organization. Community should be
aware and be conscious about health and development issues.
4. Self-Reliance
 Emphasize so that the community can take the responsibility to manage their
own health care system.
5. Social Mobilization
 Convincing all sectors to support and participate in community-based activities
through policy, advocacy, media channels, information education campaign,
organizational linkages and community mobilization and establishment of an
effective health referral system.
6. Decentralization
 This ensures empowerment and that empowerment can only be facilitated if the
administration structure provides local level political structures with more
substantive responsibilities for development initiators.
Four (4) Cornerstone of PHC
1. Active community participation
2. Intra and inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available
Members of PHC Team
1. Physician
2. Nurses
3. Midwives
4. Nurse Auxiliaries
5. Healers
6. Locally trained CHW
7. Traditional Birth Attendant (TBA)
Levels of PHC Workers
1. Village or Barangay Health Workers
 Refers to trained CHW/ HAV or TBA/ healer
2. Intermediate level of health workers
 These are general medical practitioners or their assistants, PHNs, RSI and
midwives may compose these groups.
s RSI – rural sanitary inspector
3. Health personnel of first line facility
 Consisting of physicians with same special area such as nurses, dentist,
pharmacist and other health personnel. [medical services]
Characteristics of PHC
1. Community Based - health care services should be delivered where the people are.
 2. Accessible – easily reachable by the community people especially in far flung areas.
3. Acceptable – people are agreeing and satisfied with the health care services.
4. Sustainable – health care services should be successfully utilized, maintained and
continued needs with CAI and CFP.
5. Affordable – traditional herbal medicines and other alternative forms of healing must
use together with the essential drugs.
Fundamental Services of Primary Health Care
 Herbal Medicine
 Herbalism
 Acupressure
 Acupuncture

EPIDEMIOLOGY AND HEALTH STATISTICS

Epidemiology identifies the distribution of diseases, factors underlying their source and
cause, and methods for their control; this requires an understanding of how political, social and
scientific factors intersect to exacerbate disease risk, which makes epidemiology a unique
science. Nevertheless, its definition as a science is debated; among the criticisms of the field
are that epidemiology is an inexact science that it is simply a set of tools used by other
disciplines, and that its dependence on observational data makes it a form of journalism rather
than a science. Statistics are important to health care companies in measuring performance
success or failure. Analysts map the overall growth and viability of a health care company using
statistical data. Statistical information is invaluable in determining the combination of goods and
services to produce, the right resources to allocate in producing them and to which populations
to offer them. Reliable statistical information minimizes the risks of health care trade-offs.
Innovative medicine begins and ends with statistical analysis. Epidemiology and Community
health are two inseparable words in public health system. This is because they deal with
prevention of disease, promotion of health and efficiency through organized community efforts.
Epidemiology deals with the frequencies and types of illnesses and injuries that affect
population while community health deals with the services that aim at protecting the health of
the community.

Epidemiology

The word epidemiology is derived from Greek terms- "epi" – upon, among, "demos"—
people, district, "logos" — study, word, discourse. Epidemiology deals with the
frequencies and types of illnesses and injuries in group of people and with factors that influence
their distribution.

Jekel, Elmore and Katz (1996), defined epidemiology as the study of factors that
determine the occurrence and distribution of disease in a population. Onwasigwe (2004),
views epidemiology as the study of the causes, distribution, determinants and deterrent of
diseases, injuries and other health related condition in human population.

In summary, epidemiology is the study of factors that affect health of population. Therefore,
epidemiology serves as the: cornerstone of methodology of public health research,
evidenced based medicine, and means of identifying risk factors for diseases and
determining optimal treatment approaches to clinical practice. It is used in: It is used
in: Studying the history of diseases in population in terms of profile, time & trends, determining
the most common causes of death, diseases and disability, community diagnosis in terms of
morbidity, and mortality rates and ratio, determining the effective control method of disease
when known, provision of data for proper planning and evaluation of health services, identifying
deficiencies in ongoing programs, and identifying the priority areas for medical research.

There are basic terms in Epidemiology and these are:

1. Epidemics which means the occurrence of the disease or groups of illnesses of

similar nature clearly in excess of the expected rate for the place and time.
2. Pandemic which is an epidemic usually affecting a large proportion of the
populations occurring over a wide geographic area.
3. Endemic which refers to the constant presence of a disease or infectious agent
within a given geographic area or population group.
4. Sporadic which is the scattered about disease with cases occurring irregular,
haphazardly from time to time and generally infrequently.
5. Exotic in which the disease is imported into a country example of these is the
malaria in United Kingdom.

Health Statistics

Refers to the systematic study of vital events such as births, illnesses, marriages,
divorce/ separation, and deaths. It determines the health status of the community. It is the
statistics of disease (morbidity) and death (mortality) indicate the state of health of a
community and the success or failure of health work. Statistics on population and the
characteristics such as the age and sex distribution are obtained from the NSO/ PSA, the office
in-charged with registering vital facts in the country. Births and Deaths are registered in the
office of the LCR (Local Civil Registrar) of the municipality or city. The LCR of the municipality is
usually the Municipal Treasurer or the Municipal Health Officer. In cities, births and deaths are
registered at the City Health Office. Sources of data includes the population census,
registration of vital data such as the voter’s ID, health surveys, and studies and
researches.

Vital Events
 1. Birth: coming into being, the act or process of being born
2. Death: the cessation of all physical and chemical processes that invariably occurs in
all living things
3. Marriage: the institution whereby man and woman are joined in a special kind of
social and legal dependence for the purpose of founding and maintaining a family.
[includes divorce, annulment, separation]
4. Migration: the transfer of one individual from one locality to another. [transfer of
residency]
5. Health Indicators: a list of information which would determine the health of a
particular community like population, CDR, CBR, IMR and MMR, etc.

Vital and Health Statistics

 Specific Rate: relationship is for a specific population class or group. It limits the
occurrences of the event to the portion of the population definitely exposed to it.
 Crude Birth Rate: a measure of one characteristic of the natural growth or increase of
population.
 Crude Death Rate: a measure of one mortality from all causes which may result in a
decrease of population.
 Infant Mortality Rate: measures of the risk of dying during the 1st year of life. It is a
good index of the general health condition of a community since it reflects the changes
in the environment and medical conditions of a community.
 Maternal Mortality Rate: measures the risk of dying from causes related to
pregnancy.
 Fetal Death Rate: measures pregnancy wastage. Death of the product of conception
occurs prior to its complete expulsion, irrespective of duration of pregnancy.
 Neonatal Death Rate: measures the risk of dying during the 1st month of life. May
serve as index of the effects of prenatal care and obstetrical management on the
newborn.
 Specific Death Rate: describes more accurately the risk of exposure of certain classes
or groups to a particular disease.
 Incidence Rate: measures the frequency of occurrences of the phenomenon during a
given period of time. Deals with new cases only.
 Attack Rate: a more accurate measure of the risk of exposure. Useful in
epidemiological investigations. Fresh data only, old data are not included
 Proportionate Mortality Rate: shows the numerical relationship between deaths
from a cause or groups of causes, age and the total number of deaths from all causes in
all ages taken together. Not a measure of risk of dying. Include elders and the children
 Case Fatality Rate: index of the killing power of a disease. It is also influenced by
incomplete reporting and poor morbidity data.

Formulas for Computation of Vital and Health Statistics

A. Crude Death Birth (CDR)

 total death ∈a given year
CDR¿ x 100
Average∨mid year population of a year
B. Age-specific Death Rate (ASDR)
No. of death at age a
ASDR = x 1000
Mid year population of a given year at age a
C. Infant Mortality Rate (IMR)
Nos . of infant death ∈a year
IMR = x 1000
Nos . of live birth∈a year
D. Neonatal Mortality Rate
Death under one months
NMR= x 1000
No . of live birth∈a year
E. Post-neonates Mortality Rate
Death between 1 st∧11 complet months
PNMR= x 1000
Nos of live birth
F. Maternal Mortality Rate
Nos . of maternal death ∈a year
MMR = x 1000
Nos . of live birth∈a year
Presentation of Data

- Observation of events in the community are presented in the form of tables, charts and
graphs.
- Graphs, Charts and Tables
 Help illustrate or clarify points which deserve attention, Graphical presentation is
attractive, easy to understand and reveals major points where attention is
needed without the necessity of computing.
- Line or Curve Graphs
 Show peaks, valleys and seasonal trends. It is used to show the trend of births
and death rates over periods of time.
- Bar Graphs
 Each bar represents or expresses as quantity in terms of rates or percentage of a
particular observation like cause of illness and deaths.
- Area Diagrams (Pie Chart)
 Show the relative importance of parts to the whole.
 10 LEADING CAUSES OF DEATH 10 LEADING CAUSES OF
IN THE PHILIPPINES (DOH, SICKNESS IN THE PHILIPPINES
2019) (DOH, 2017)

1. Diseases of The Heart 1. Respiratory Infection

2. Diseases of The Vascular System, 2. Hypertension
3. Pneumonias, 3. Pneumonia
4. Malignant Neoplasms/Cancers, 4. Urinary Tract Infection
5. All Forms of Tuberculosis, 5. Bronchitis
6. Accidents, 6. Influenza
7. COPD And Allied Conditions, 7. Diarrheal Diseases
8. Diabetes Mellitus,
8. Asthma All Forms
9. Nephritis /Nephritic Syndrome
9. Tb Respiratory
10. And Other Diseases of Respiratory
10. Acute Febrile Illness
System.

5 LEADING CAUSES OF IMR IN THE 5 LEADING CAUSES OF MMR IN

PHILIPPINES (DOH, 2018) THE PHILIPPINES (DOH, 2019)

1. Pneumonia 1. Severe Bleeding

2. Bacterial Sepsis of Newborn 2. Infections
3. Respiratory Distress of Newborn 3. High Blood Pressure
4. Disorders Related to Short Gestation 4. Complications from Delivery
and Low Birth Weight 5. Unsafe Abortion
5. Congenital Malformation of The
Heart

REFERENCES:

Book:

1. Castro, C. E. (2012). Community Health Nursing and Community Health Development.

Manila, Educational Publishing House

Website:

2. https://www.ncbi.nlm.nih.gov/books/NBK316278/#:~:text=Primary%20Health%20Care
%20(PHC)%20is,%E2%80%9CAlma%20Ata%20Declaration%E2%80%9D).&text=The
%20PHC%20concept%20paper%20was,Strengthening%20of%20Health%20Services
%20Division.
3. https://www.betterhealth.vic.gov.au/health/ServicesAndSupport/primary-healthcare-
explained
4. https://www.nidcd.nih.gov/health/statistics/what-epidemiology
5. https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-
uninitiated/1-what-epidemiology
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069092/
7. https://www.doh.gov.ph/statistics