Course Title: Community Health Nursing (Individual and Family)

Course No.: NCM 104

Course Description: This course deals with concepts, principles, theories and
techniques in the provision of basic care in terms of health
promotion, disease prevention, restoration and maintenance
and rehabilitation at the individual and family level. It includes
the study of the Philippine Health care Delivery System,
National Health Situation and the global context of public
health. The learners are expected to provide safe, appropriate
and holistic nursing care to individuals and family as clients in
community setting utilizing the nursing process.
Content:

Module 3: THE HEALTH CARE DELIVERY SYSTEM

Topic 1: Philippine Health Agenda, Universal Health Care

Topic 2: Primary Health Care

Topic 1: Philippine Health Agenda, Universal Health Care

Learning Targets: 1. Assume responsibility for lifelong learning, own personal

development and maintenance of competence.
2. Engage in advocacy activities to influence health and
social care service policies and access to services.
3. Model professional behavior as a community health
nurse.
PHILIPPINE HEALTH AGENDA 2010-2022
• In May 2016, the Philippines elected a new president in a landslide victory
that has been seen as an anti-establishment choice. People wanted
change and the new administration plans to deliver, promising to be more
people-focused and pro-poor.
• The first few months of the presidency have shown a strong commitment to
the promises made during the campaign, and there is optimism that the
poor and disadvantaged can look forward to beneficial changes. The new
Government’s vision for the Philippines has been swiftly translated by the
Department of Health into the Philippine Health Agenda 2016–2022.

Advance quality, health promotion and primary care

1. Conduct annual health visits for all poor families and special populations
(NHTS, IP, PWD, Senior Citizens)
2. Develop an explicit list of primary care entitlements that will become the
basis for licensing and contracting arrangements
3. Transforms elect DOH hospitals into mega-hospitals with capabilities for
multi-specialty training and teaching and reference laboratory
4. Support LGUs in advancing pro-health resolutions or ordinances (e.g. city-
wide smoke-free or speed limit ordinances)
5. Establish expert bodies for health promotion and surveillance and response

Cover all Filipinos against health-related financial risk

1. Raise more revenues for health, e.g. impose health- promoting taxes,
increase NHIP premium rates, improve premium collection efficiency.
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with PhilHealth
3. Expand PhilHealth benefits to cover outpatient diagnostics, medicines,
blood and blood products aided by health technology assessment
4. Update costing of current PhilHealth case rates to ensure that it covers full
cost of care and link payment to service quality
5. Enhance and enforce PhilHealth contracting policies for better viability and
sustainability

Harness the power of strategic HRH development

1. Revise health professions curriculum to be more primary care-oriented and
responsive to local and global needs
2. Streamline HRH compensation package to incentivize service in high-risk or
 GIDA areas
3. Update frontline staffing complement standards from profession-based to
competency-based
4. Make available fully-funded scholarships for HRH hailing from GIDA areas or
IP groups
5. Formulate mechanisms for mandatory return of service schemes for all
heath graduates

Invest in eHealth and data for decision-making

1. Mandate the use of electronic medical records in all health facilities
2. Make online submission of clinical, drug dispensing, administrative and
financial records a prerequisite for registration, licensing and contracting
3. Commission nationwide surveys, streamline information systems, and
support efforts to improve local civil registration and vital statistics
4. Automate major business processes and invest in ware- housing and
business intelligence tools
5. Facilitate ease of access of researchers to available data

Enforce standards, accountability and transparency

1. Publish health information that can trigger better performance and
accountability
2. Set up dedicated performance monitoring unit to track performance or
progress of reforms

Value all clients and patients, especially the poor, marginalized, and vulnerable
1. Prioritize the poorest 20 million Filipinos in all health programs and support
them in non-direct health expenditures
2. Make all health entitlements simple, explicit and widely published to
facilitate understanding, & generate demand
3. Set up participation and redress mechanisms
4. Reduce turnaround time and improve transparency of processes at all DOH
health facilities
5. Eliminate queuing, guarantee decent accommodation and clean
restrooms in all government hospitals

Elicit multi-sectoral and multi-stakeholder support for health

1. Harness and align the private sector in planning supply side investments
 2. Work with other national government agencies to address social
determinants of health
3. Make health impact assessment and public health management plan a
prerequisite for initiating large-scale, high-risk infrastructure projects
4. Collaborate with CSOs and other stakeholders on budget development,
monitoring and evaluation

Universal Health Coverage

Key facts...
• At least half of the world’s population still do not have full coverage of
essential health services.
UHC by WHO
• UHC means that all individuals and communities receive the health services
they need without suffering financial hardship. It includes the full spectrum
of essential, quality health services, from health promotion to prevention,
treatment, rehabilitation, and palliative care.
All people having access to quality health services (including prevention,
promotion, treatment, rehabilitation and palliation) without suffering the financial
hardship associated with paying for care
o All people (population coverage)
o Having access to quality health services (service coverage)
o Without suffering financial hardship associated with paying for care
(financial risk protection)

Topic 2: : Primary Health Care

Learning Targets: 1. Define primary health care.

2. Outline the historical background of PHC.
3. Enumerate the key principles of PHC.
4. Describe traditional and alternative health care
modalities that may be applied in communities.
5. Assume responsibility for lifelong learning, own personal
development and maintenance of competence.
6. Engage in advocacy activities to influence health and
social care service policies and access to services.
7. Model professional behavior as a community health
nurse.
Primary Health Care (PHC)

Primary Health Care (PHC) is an essential health care made universally

acceptable to individuals and families in the community by means acceptable
to them through their full participation and at a cost that the community and
country and can afford at every stage of development.

1. Brief History
▪ On September 6-12, 1978, health leaders from around 200 countries
attended the International Conference for Primary Health Care held at
Alma Ata, USSR initiated by the WHO and United Nations Children's Fund
(International Conference on Primary Health Care, Alma-Ata, 1978).
▪ Together they expressed the need for concerted efforts by all
governments and health and development workers for the protection
and promotion of health of all the people.
▪ The Alma Ata Declaration on Primary Health Care emerged from this
conference.
▪ The Alma Ata Conference made the following declarations:
O Health is a basic fundamental right.

o There exists global burden of health inequalities among populations.

o Economic and social development is of basic importance for the full

attainment of health for all.

o Governments have a responsibility for the health of their people.

▪ The PHC strategy was later adopted in the Philippines by virtue of Letter
of Instruction (LOI) 949 of 1979, making the Philippines the first country in
Asia to embark on meeting "the challenge of PHC (Bautista, 2001).
• May 1977. The 30th World Health Assembly adopted resolution which
decided that the main social target of governments and of WHO should be
the attainment by all the people of the world by the year 2000 a level of
health that will permit them to lead a socially and economically productive
life.
• September 6-12, 1978. International Conference in PHC was held in this year
at Alma Ata, USSR (Russia)
• October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued
Letter of Instruction (LOI) 949 which mandated the then Ministry of Health
to adopt PHC as an approach towards design, development, and
 implementation of programs which focus health development at the
community level.

2. Legal Basis
October 19, 1979 – Letter of Instruction (LOI) 949, the legal basis of PHC was signed
by Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the
design, development and implementation of programs focusing
on health development at community level.

Definition of Primary Health Care

▪ The WHO defines Primary Health Care “an essential health care made
universally acceptable to individuals and families in the community by
means acceptable to them through their full participation and at a cost
that the community and country and afford at every stage of
development.”
▪ According to the Alma Ata Deaclaration, PHC “is 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 their
development in the spirit of self reliance and self-determination.”
▪ The universal goal of PHC as stated in the Alma Ata Declaration is "health
for all" by the year 2000.
▪ This policy agenda of "health for all by the year 2000" technically was a
global strategy employed for achieving three main objectives:
(1) promotion of healthy lifestyle
(2) prevention of diseases
(3) therapy for existing conditions.

Goals

▪ The ultimate goal of primary health care is better health for all. WHO has
identified five key elements to achieving that goal:
1. Reducing exclusion and social disparities in health (universal
coverage reforms);
 2. Organizing health services around people’s needs and
expectations (service delivery reforms);
3. Integrating health into all sectors (public policy reforms);
4. Pursuing collaborative models of policy dialogue (leadership
reforms); and
5. Increasing stakeholder participation.

Alma Ata Declaration

• The Declaration of Alma-Ata was adopted at the International

Conference on Primary Health Care (PHC), Almaty (formerly Alma-Ata),
Kazakhstan (formerly Kazakh Soviet Socialist Republic), 6-12 September
1978
• Eight essential elements based on the Alma Ata on PHC:
E – Education for Health

L - Locally Endemic Disease Control

E - Expanded Program for Immunization

M- Maternal and Child Health including responsible parenthood

E- Essential Drugs
N- Nutrition
T - Treatment of communicable and non-communicable diseases

S- Safe water and good waste disposal

ELEMENTS

The following are the eight (8) essential elements of primary health care:

1. Education for Health

• This is one of the potent methodologies for information dissemination. It
promotes the partnership of both the family members and health workers
in the promotion of health as well as prevention of illness.

2. Locally Endemic Disease Control

• The control of endemic disease focuses on the prevention of its occurrence
to reduce morbidity rate. Example Malaria control and Schistosomiasis
control
3. Expanded Program on Immunization
• This program exists to control the occurrence of preventable illnesses
especially of children below 6 years old. Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other preventable disease are given for
free by the government and ongoing program of the DOH

4. Maternal and Child Health and Family Planning

• The mother and child are the most delicate members of the community. So
the protection of the mother and child to illness and other risks would ensure
good health for the community. The goal of Family Planning includes
spacing of children and responsible parenthood.

5. Environmental Sanitation and Promotion of Safe Water Supply

• Environmental Sanitation is defined as the study of all factors in the man’s
environment, which exercise or may exercise deleterious effect on his well-
being and survival. Water is a basic need for life and one factor in man’s
environment. Water is necessary for the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic promotion of health.

6. Nutrition and Promotion of Adequate Food Supply

• One basic need of the family is food. And if food is properly prepared then
one may be assured healthy family. There are many food resources found
in the communities but because of faulty preparation and lack of
knowledge regarding proper food planning, Malnutrition is one of the
problems that we have in the country.

7. Treatment of Communicable Diseases and Common Illness

• The diseases spread through direct contact pose a great risk to those who
can be infected. Tuberculosis is one of the communicable diseases
continuously occupies the top ten causes of death. Most communicable
diseases are also preventable. The Government focuses on the prevention,
control and treatment of these illnesses.

8. Supply of Essential Drugs

• This focuses on the information campaign on the utilization and acquisition
of drugs. In response to this campaign, the GENERIC ACT of the Philippines
 is enacted. It includes the following drugs: Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and
Pyrazinamide, Ethambutol, Streptomycin, Albendazole, Quinine

Rationale

Adopting primary health care has the following rationales:

Magnitude of Health Problems

Inadequate and unequal distribution of health resources

Increasing cost of medical care

Isolation of health care activities from other development activities.

Objectives

1. Improvement in the level of health care of the community

2. Favorable population growth structure
3. Reduction in the prevalence of preventable, communicable and
other disease.
4. Reduction in morbidity and mortality rates especially among infants
and children.
5. Extension of essential health services with priority given to the
underserved sectors.
6. Improvement in basic sanitation
7. Development of the capability of the community aimed at self-
reliance.
8. Maximizing the contribution of the other sectors for the social and
economic development of the community.

Types of PHC workers

There are two types of primary health care workers in the Philippines:

1. Barangay Health Worker or Village Health Worker

2. Intermediate level Primary Health Worker
Four Pillars

1. Active Community Participation

2. Intra and Inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

Major Strategies

1. Elevating health to a comprehensive and sustained national effort

• Attaining health for all Filipinos will require expanding participation in
health and health-related programs whether as service provider or
beneficiary. Empowerment to parents, families and communities to
make decisions of their health is the desired outcome.

2. Promoting and supporting community managed health care

• The health in the hands of the people brings the government closest to the
people. It necessitates a process of capacity building of communities and
organization to plan, implement and evaluate health programs at their
levels.

3. Increasing efficiency in health sector

• Using appropriate technology will make services and resources required for
their delivery, effective, affordable, accessible and culturally acceptable.
• The development of human resources must correspond to the actual needs
of the nation and the policies it upholds such as PHC.

4. Advancing essential national health research

• Essential National Health Research (ENHR) is an integrated strategy for
organizing and managing research using intersectoral, multi-disciplinary
and scientific approach to health programming and delivery.

KEY PRINCIPLES OF PRIMARY HEALTH CARE

Primary health care is run with the following principles:

 1. 4 A’s = Accessibility, Availability, Affordability and Acceptability,
Appropriateness of health services.
• The health services should be present where the supposed recipients are.
They should make use of the available resources within the community,
wherein the focus would be more on health promotion and prevention of
illness.

2. Community Participation
• Community participation is the heart and soul of primary health care.

3. People are the center, object and subject of development.

• Thus, the success of any undertaking that aims at serving the people is
dependent on people’s participation at all levels of decision-making;
planning, implementing, monitoring and evaluating. Any undertaking must
also be based on the people’s needs and problems (PCF, 1990)
• Example: Scheduling of Barangay Health Workers in the health center
Barriers of Community Involvement

Barriers of Community Involvement

• Lack of motivation
• Attitude
• Resistance to change
• Dependence on the part of community people
• Lack of managerial skills

4. Self-reliance
• Through community participation and cohesiveness of people’s
organization they can generate support for health care through social
mobilization, networking and mobilization of local resources.
5. Partnership between the community and the health agencies in the
provision of quality of life.
• Providing linkages between the government and the non-government
organization and people’s organization.

6. Recognition of interrelationship between the health and development

• Health is defined as not merely the absence of disease. Neither is it only a
 state of physical and mental well-being. Health being a social
phenomenon recognizes the interplay of political, socio-cultural and
economic factors as its determinant.
• Development is the quest for an improved quality of life for all.
Development is multidimensional. It has political, social, cultural, institutional
and environmental dimensions (Gonzales 1994). Therefore, it is measured
by the ability of people to satisfy their basic needs.
7. Social Mobilization
• It enhances people’s participation or governance, support system
provided by the government, networking and developing secondary
leaders.

8. Decentralization
• This ensures empowerment and that empowerment can only be facilitated
if the administrative structure provides local level political structures with
more substantive responsibilities for development initiators. This also facilities
proper allocation of budgetary resources.

10 DOH APPROVED HERBAL MEDICINE

• As part of primary health care and because of the increasing cost of drugs,
the use of locally available medicinal plants and herbs in the Philippine
backyard and field have been found to be effective in the treatment of
common ailments as attested to by the National Science Development
Board, other government and private agencies/ persons engaged in
research.

HERBAL MEDICINE REPUBLIC ACT 8423

• Otherwise known as TAMA TRADITIONAL AND ALTERNATIVE MEDICINE ACT
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.

10 HERBAL MEDICINES APPROVED BY THE DOH

S Sambong
A Akapulko
N Niyog-niyogan
T Tsaang Gubat
A Ampalaya
L Lagundi
U Ulasimang Bato
B Bawang
B Bayabas
Y Yerba Buena

Reminders on the Use of Herbal Medicine

• Avoid the use of insecticides as these may leave poison on plants.
• In the preparation of herbal medicine, use a clay pot and remove cover
while boiling at low heat.
• Use only the part of the plant being advocated.
• Follow accurate dose of suggested preparation.
• Use only one kind of herbal plant for each type of symptoms or sickness.
• Use only half the dosage prescribed for fresh parts like leaves when using
dried parts.
• Decoctions loose potency after some time.
• Dispose of decoctions after one day.
• To keep fresh during the day, keep lukewarm in a flask or thermos.
• Leaves, fruits, flowers or nuts must be mature before harvesting.
• Less medicinal substances are found on young parts.
• Stop giving the herbal medication in case untoward reaction such as
allergy occurs. If signs and symptoms are not relieved after 2 or 3 doses of
herbal medication, consult a doctor

1. SAMBONG
• A plant that reaches 1 ½ to 3 meters in height
with rough hairy leaves.
• Young plants around mother plant may be
separated when they have three or more
leaves.
• Scientific Name: Blumea balsamifera
USES:
1. Anti-edema
2. Diuretic
3. Anti-urolithiasis
PREPARATION:
 • Boil chopped leaves in water for 15 minutes until one glassful remains.
Cool and strain.
• Divide decoction into 3 parts. Drink one part 3 times a day.
NOTE: Sambong is not a medicine for kidney infection

2. AKAPULKO
• Ringworm Bush
• Bayas-bayasan
• This plant is about 1 to 2 meters tall
• The leaves are embraced with 8 to 20
oblongelliptical shaped leaflets It has
flowers with oblong sepals
• Scientific Name: Cassia alata
USES:
• Anti-fungal: Tinea Flava, Ringworm, Athlete ’s Foot and Scabies
PREPARATION:
• Fresh, matured leaves are pounded.
• Apply as a soap to the affected part 1 to 2 times a day.

3. NIYUG-NIYOGAN
• Chinese Honey Suckle
• A vine which bears tiny fruits
and grows wild in
backyards.
• The seeds must come from
mature, dried but newly
opened fruits.
• Propagated through stem
cuttings about 20cm in
height.
• Scientific Name: Quisqualis indica L.
USES:
Anti-helmintic (used to expel parasitic worms.)
PREPARATION:
• Seeds of niyug-niyogan are eaten raw two hours before the patient’s
last meal of the day.
 • Adults may take 10 seeds; children 4 to 7 years of age may eat up to
four seeds only; ages 8 to 9 may take six seeds and seven seeds may be
eaten by children 10 to 12 years old.
• Not to be given to children below four years old.

4. TSAANG GUBAT
• Forest Tea or Wild Tea
• A shrub with small, shiny nice-
looking leaves that grows in wild
uncultivated areas and forests.
• Scientific Name: Carmona retusa
USES:
• Diarrhea
• Stomach ache
PREPARATION:
• Boil the following amount of chopped leaves in 2 glasses of water for
15 minutes or until amount of water goes down to 1 glass. Cool and
strain.
• Wash leaves and chop. Boil chopped leaves in 1 glass of water for 15
minutes. Cool and filter/strain and drink.

5. AMPALAYA
• Bitter Gourd or Bitter melon
• A climbing vine with tendrils that
grow up to 20 cms long.
• Leaves are heartshaped, which are 5
to 10 cms in diameter
• Fruits have ribbed and wrinkled
surface that are fleshy green with
pointed ends at length and has a
bitter taste.
• Scientific Name: Momordica
charantia
USES:
• Lowers blood sugar levels
• Diabetes Mellitus (Mild-non insulin dependent)
PREPARATION:
• Gather and wash young leaves very well.
 • Chop.
• Boil 6 tablespoons in two glassfuls of water for 15 minutes under low
fire.
• Do not cover pot.
• Cool and strain.
• Take one third cup 3 times a day after meals.

6. LAGUNDI
• 5 Leaved-Chaste Tree
• A shrub growing wild in vacant lots
and waste land.
• Matured branches are planted.
• The flowers are blue and bellshaped.
• The small fruits turn black when ripe. It
is better to collect the leaves when
are in bloom.
• Scientific Name: Vitex negundo

USES:
• Asthma and cough
• Fever, Dysentery, Colds & Pain
• Skin diseases and wounds
• Headache Rheumatism, sprain, contu sions, insect bites.
• Aromatic bath for sick patients
PREPARATION:
• For Asthma, cough and fever, boil chopped raw fruits or leaves in 2
glasses of water left for 15 minutes until the water left in only 1 glass
(decoction). Strain.
• For Dysentery, colds and pain, boil a handful of leaves and flowers in
water to produce a glass full of decoction 3 time a day.
• For skin diseases (dermatitis, scabies, ulcer, eczema) and wounds,
prepare a decoction of the leaves. Wash and clean the skin/wound with
the decoction.
• For headache, crushed leaves may be applied on the forehead.
• For rheumatism, sprain, contusions and insect bites, pound the leaves
and apply on the affected part.
7. ULASIMANG BATO
• Silver bush or Shiny bush
• Pansit-pansitan
• A weed with heartshaped
leaves that grow in shady parts
of the garden and yard.
• Scientific Name: Peperomia
pellucida
USES:
• Lowers uric acid (Rheumatism and Gout)
PREPARATION:
• Wash the leaves well.
• One and a half cup leaves are boiled in two glassfuls of water over low
fire.
• Do not cover pot.
• Cool and strain.
• Divide into three parts and drink each part 3 times a day a day.
May also be eaten as salad.
• Wash the leaves well.
• Prepare one and a half cups of leaves (not closely packed).
• Divide into three parts and take as salad 3 times a day.

8. BAWANG
• Garlic
• A low herb and grows up to sixty cms
high
• Leaves are flat and linear
• Bulbs consist of several tubers
• Scientific Name: Allium sativum
USES:
• For hypertension
• Toothache
• Lowers cholesterol levels in the blood
PREPARATION:
• May be fried, roasted, soaked in vinegar for 30 minutes, or blanched
in boiled water for 5 minutes.
• Take two pieces three times a day after meals.
 • For toothache, pound a small piece and apply to affected part.
CAUTION: Take on full stomach to prevent stomach and intestinal
ulcers.

9. BAYABAS
• Guava
• A tree about 4 to 5 meters high with tiny
white flowers with round or oval fruits
that are eaten raw.
• Scientific Name: Psidium guajava

USES:
• For washing wounds
• For toothache
• For diarrhea
PREPARATION:
• Warm decoction is used for gargle.
• Freshly pounded leaves are used for toothache.
• Guava leaves are to be washed well and chopped.
• Boil for 15 minutes at low fire. Do not cover pot.
• Cool and strain before use.

10. YERBA BUENA

• Peppermint
• A small multibranching aromatic
herb.
• The leaves are small, elliptical and
with toothed margin.
• The stem creeps to the ground, and
develop roots.
• Scientific Name: Mentha cordifelia
USES:
• For pain in different parts of the body as head ache, stomach ache
• Rheumatism, arthritis and headache
• Cough and cold
• Swollen gums & toothache
• Menstrual and gas pain
• Nausea and fainting
 • Insect bites & Pruritus

PREPARATION:
• For pain in diff. parts of the body, boil chopped leaves in 2 glasses of
water for 15 minutes. Cool and strain.
• For rheumatism, arthritis and headache, crush the fresh leaves and
squeeze sap. Massage sap on painful parts with eucalyptus.
• For cough and cold, get about 10 fresh leaves and soak in a glass of hot
water. Drink as tea. Acts as an expectorant.
• For toothache, cut fresh plant and squeeze sap. Soak a piece of cotton
in the sap and insert this in aching tooth cavity. Mouth should be rinsed
by gargling salt solution before inserting the cotton. To prepare salt
solution: add 5g of table salt to one glass of water.
• For Menstrual pain and gas pain, soak a handful of leaves in a glass of
boiling water. Drink infusion. It induces menstrual flow and sweating. 
• For nausea and fainting, crush leaves and apply at nostrils of patient.
• For insect bites, crush leaves and apply juice on affected part or pound
leaves until paste-like and rub this on the affected part.

Learning Activity:

1. Choose a specific public health program.

2. Identify its goals, objectives, and strategies for implementation.
3. Analyze the program’s goals and objectives based on the key principles
of PHC.