Community Health

♥ Under the office of the president

- Many are from Mindanao

Nursing
- Hospice home care
- Parish Community Nursing
- Faith community nursing
Lectured by: Z. Famorca, PhD, RN DOTS
- Treatment partner – follows up medication
“Public health is supposed to be given for free” FALSE ♥ PHN appoints a treatment partner
Financing of health services ♥ Another health worker that is accessible
- Out of pocket – BHW
- Health maintenance organization (Phil Health)
3. Population/aggregate—focused
- Free at the point of care
♥ Government—Taxes are paid - “The greater good of the majority”
Test taking technique - Community Diagnosis
- When choosing numbers choose the middle ♥ Vital Statistics
ground ♥ Demography
- Do not choose the extreme numbers - Magnitude (prevalence) of a problem
CHN: Definition
♥ A criterion for priority setting
1. Developmental Services
4. Promotive and preventive
- Development of health capability of Individual,
Family, Group, Community - Preventive treatment, e.g. DOTS
♥ Groups with common susceptibility - Health Education
♥ Same working group 5. Pre-paid service
- Enabling service self- reliance - Taxation (public and school health)
- Health education—done for health promotion - Passed on to consumer (occupational)
♥ Patient Education—Done when person
-
is sick
- Community organizing 6. Generalist Practice
Transfer of Technology

Labor Code: Health, Safety and Welfare Benefits

2. Community-based
- Book 4: Health, safety and welfare benefits
- Catchment
Number of workers OH services
- Natural environment of people 10-50 Graduate first aider who may be
Home PHN one of the workers
50-200 Non-hazardous: full-time first
School  SHN
aider
Workplace OHN Hazardous workplace: OHN
200-300 OHN, Part-time physician and
3 fields of CHN Practice dentist (at least 2hrs a day),
- Case-finding of CHN practice emergency clinic (1 bed: 100
♥ Direct Sputum Smear Microscopy (TB) workers) or hospital within 5 km
>300 Full time DMD and MD
♥ Weighing Scale or tape measure for
RA 124—mandates all schools to have a school clinic for
mid-upper arm circumference
the treatment of minor ailments and attendance to
(Malnourishment)
emergency cases (1947)
2 types of community:
- School health physician reports to the board of
- Geo political community
health (DOH)
♥ Barangay
♥ City Functions of OHN and SHN
♥ Province 1. Health care provider
- Phenomenological - Promotive and preventive services
GIDA- Geographically Isolated and Deprived Areas ♥ Health advocacy
- Cooperative Development Authority ♥ Health education and counseling
♥ Immunization, prenatal care
Margadi
BSN 2013
 - Treatment of common ailments and emergency
nursing care
♥ CD control
- Screening for health problems:
♥ School health and nutrition survey—
done on the 1st visit by the nurse and
every 3 years thereafter
♥ Random/rapid classroom inspection
♥ Annual individual health inspection
o Interview
o Height and weight
measurement
♥ Head to foot examination for
cleanliness, skin disease and other
obvious abnormalities
♥ Visual acuity test: a child with visual
acuity of 20/40 or poorer to be referred
♥ Ear exam and hearing acuity test:
otoscopy, whisper test, ballpen click
test or with the use of tuning fork
(ototoxicity for Streptomycin)
2. Environmental Manager
- Monitoring environmental conditions
- Recognizing and reporting accident and health
hazards in workplace/school
- Healthful school living
- Application of ergonomic principles (physical
environment)
3. Health coordinator
- Making referrals to other agencies and health
personnel
- Coordination with public health nurse, e.g. for
immunization of school children
Public Health (C.E.Winslow)
Philosophy of public heatlh
- “Health and longevity” as “birth rights”
- Premature death (*untimely death)
Objectives of public health
- To prevent disease
- To prolong life
- To promote health and efficiency
Organized community efforts
- People
- RHU Primary Health Care
- Private sector
Philosophy of public health nursing (Margaret Shetland)
- PHN is based on the worth and dignity of man
♥ Contribute to the integrity of the
Individual, Family and Community
- The family is the basic unit of service in PHN
- Physical and emotional health are inseparable
♥ Consider physical and emotional
aspects of the needs of all the members
of the family
Public Health Nursing (WHO expert committee on
nursing)
- PHN is a special field of nursing that combines
the skills of:
♥ Public health
♥ Nursing
♥ Some phases of social assistance –
feeding program
4P’s Pantawid pamilyang Pilipino Program
(CCT- conditional cash transfer)
- Poverty alleviation
♥ MDG1: Eliminate hunger and poverty
th
- 5 Quintile and instrument to identify “True
Poor”
Benefits:
1. P500/month
2. For every qualified child (max of 4 up to 15yrs)
- P300/month for 10 mos.
Conditions:
1. 85% of class days, students should be present
2. Immunization up to the age of 4
3. Children will be in the garantisadong pambata
program
- PHN functions as part of a total public health
program
♥ Health team
♥ 1 municipal health plan
- Objectives of PHN
♥ Promotion of health
♥ Improvement of conditions in the
physical and social environment
♥ Rehabilitation
♥ Prevention of illness and disability
Basic competencies of the Public Health Nurse
- Patient care competencies
Margadi
BSN 2013
 ♥ CHN process Natural hx of disease
♥ Nursing procedures during clinic and Pre- Pathogenesis
home visits Pathogenesis
♥ Surveillance Interaction
- Health promotion and education
- Communication
- Collaboration: community organizing
- Empowering competencies
Millennium Summit: September 6-8, 2000
♥ Legal responsibility
1. Eradicate extreme poverty and hunger
♥ Ethico-moral responsibilities
2. Achieve universal primary education
♥ Personal and professional development
3. Promote gender equality and empower women
- Enabling competencies
4. Reduce by2/3 the under 5 mortality rate
♥ Management of resources and
(1990:80/1000 live births 2015: 26.7/1000)
environment
5. Reduce by ¾ the maternal mortality rate (1990:
♥ Record management
2.09/1000 live births 2015: 52/1000 live
- Enhancing competencies
births)
♥ Research
6. Combat HIV/AIDS, malaria and other disease
♥ Quality improvement
1993: eradication of
Level of Prevention
1. Polio
- Target population:
2. Neonatal Tetanus
♥ Beneficiaries (For whom?)
3. Measles
♥ Purpose of the nursing action: aspect of
4. Rabies
prevention (for what?)
7. Ensure environmental sustainability
Primary level
8. Develop a global partnership for development
- Target population: well individuals, families,
World Health Organization (MDG4-6)
groups and communities
- Aspects of prevention
The Department of Health
♥ General health promotion
Vision- Mission
♥ Specific disease prevention
Vision
o Prevent from a single person
To staunch advocate, model and leader of health for all
♥ Specific protection
in the Philippines
o Groups of people
“A global leader for attaining better health
o ASIN Law- “An Act for Salt
outcomes, competitive and responsive health
Iodization Nationwide”
care system, and equitable health financing.”
Secondary Level
- Target Population: Early sick + subclinical cases
Mission
(asymptomatic) “To guarantee equitable, sustainable and quality health
- Aspects of prevention for all Filipinos, especially the poor, and to lead the
♥ Early diagnosis and prompt treatment quest for excellence in health.”
♥ Prevention of complications
Tertiary Level Roles and functions of the DOH
- Target population: Late sick: convalescent, 1. Leader
disabled, complicated case, terminal ill a. Planner and policy-maker
b. Regulator of health services
c. Advocate in the adoption of health policies,
plans and programs

Margadi
BSN 2013
 2. Enabler and capacity builder
a. Develop new strategies in health
b. Initiate public discussion on health issues Goals
and disseminate info on research outputs Better Health Responsive Equitable health
c. Ensure standards of health promotion, outcomes health system financing
protection and care (training)
Health care delivery system of the Philippines
3. Administrator of specific services Primary Level
a. Manage selected national health facilities - Promotion and prevention
b. Administer direct services for emergent - Management of prevalent conditions
health concerns that require new - Out-patient services
complicated technologies Secondary
c. Administer health emergency responses - Hospitalization
Tertiary
- Specialized care
♥ Specially trained personnel
Universal Health Care ♥ Highly departmentalized
(2010-2016)
♥ Sophisticated equipment
FOURmula One for
Health (2005-2010) National hospitals/DOH national office/ medical
centers/ university hospitals/ special hospitals
Health Sector Reform
Agenda (1999-2004)
Center for health development
Prove Health Board
Provincial hospital (PHO) Chair: Governor
Priority Health Policy Directions of the Aquino Vice-chair: IPHO
Administration District hospital (DHO)

RHU/CHC/CHO Municipal/city Health Board

Financial Risk Chair: Mayor
Protection
BHS Vice-chair: Municipal Health Officer

RA 7160—devolution code
Health
Achieving
facilities
MDGmax
enhancement Inter Local Health System
- To ensure quality of health care service at the
local level integrate hospital and public
health services  holistic health care
Universal Health Care - Inter Local Health Zone (ILHZ)
Strategies ♥ Clustered municipalities (defined
1 2 3 population within a defined area)
Health Financing Service Delivery Policy and
♥ Primary level facilities (RHU’s and
regulation
BHS’s)
6 5 4
Health Human Health Governance for ♥ Central referral hospital
Resource information Health

Margadi
BSN 2013
Components of the ILHZ
- People—may vary, according to WHO, between
100, 000 to 500, 000
- Boundaries—to determine accountability of
health service providers
- Health facilities- secondary level hospital
(district of provincial), RHU’s BHS’s and other
health facilities
- Health workers—both government and non-
government
Two-way referral system
- Communication among facilities
The RHU team

Margadi
BSN 2013