CONCEPT OF PUBLIC HEALTH

& COMMUNITY HEALTH

NURSING
DEFINITION & PHILOSOPHY
HEALTH
◼ State of complete physical,
mental, and social well
being, not merely the
absence of disease or
infirmity
DETERMINANTS OF HEALTH
 INCOME & SOCIAL STATUS
◼ Higher income and social status are linked
to better health
 EDUCATION
◼ Low education levels are linked with poor
health, more stress, and lower self-
confidence
 PHYSICAL ENVIRONMENT
◼ Safe water & clean air, healthy workplaces,
safe houses, communities & roads all
contribute to good health
 EMPLOYMENT & WORKING CONDITIONS
◼ People in employment are healthier, particularly
those who have more control over their working
conditions
 SOCIAL SUPPORT NETWORKS
◼ Greater support from families, friends &
communities is linked to better health
 CULTURE
◼ Customs & traditions, & the beliefs of the family
& community all affect health
 GENETICS
◼ Inheritance plays a part in determining lifespan,
healthiness & the likelihood of developing
certain illnesses
 PERSONAL BEHAVIOR & COPING SKILLS
◼ Balanced eating, keeping active, smoking,
drinking, and how we deal with life’s stresses
& challenges all affect health
 HEALTH SERVICES
◼ Access & use of services that prevent & treat
disease influence health
 GENDER
◼ Men & women suffer from different types of
diseases at different ages
ECOSYSTEM INFLUENCE ON OPTTIMUM LEVEL OF FUNCTIONING (OLOL)
POLITICAL
Safety
Oppression
People Empowerment

BEHAVIOR
SOCIOECONOMIC
Culture
Employment OLOF Habits
Education Individuals Mores
Housing Family Groups Ethnic Customs
ENVIRONMENT Communiti HEREDITY
Air es Generic Endowment
Food Populations
-Defects
-Strengths
Water waste HEALTH CARE -Risks
Urban/rural DELIVERY SYSTEM Familial
Noise Promotive Ethnic
Radiation Racial
Preventive
Pollution Curative
Rehabilitative
Public Health
 Art of applying science in the
context of politics so as to reduce
inequalities in health while ensuring
the best health for the greatest
number
 Is a core element of government’s
attempts to improve & promote the
health and welfare of their citizens
 CORE BUSINESS OF PUBLIC
HEALTH
 DISEASE CONTROL
 INJURY PREVENTION
 HEALTH PROTECTION
 HEALTHY PUBLIC POLICY
(workplace, housing, food, water,
etc)
 PROMOTION OF HEALTH &
EQUITABLE HEALTH GAIN
 ESSENTIAL PUBLIC HEALTH
FUNCTIONS
 Health situation monitoring & analysis
 Epidemiological surveillance/disease
prevention & control
 Development of policies & planning in
public health
 Strategic management of health systems
& services for population health gain
 Regulation & enforcement to protect
public health
 Human resources development &
planning in public health
 Health promotion, social participation
& empowerment
 Ensuring the quality of personal &
population based health services
 Research, development &
implementation of innovative public
health solutions
PHILOSOPHY (Dr. Margaret Shetland)

COMMUNITY
HEALTH NURSING
IS BASED ON THE
WORTH &
DIGNITY OF MAN
CONCEPTS
 The primary focus of community health
nursing practice is on health promotion
 Community health nursing practice is
extended to benefit not only the individual
but the whole family & community
 Community health nurses are generalists
in terms of their practice through life’s
continuum
 Contact with the client and/or the family
may continue over a long period of time
which include all ages & all types of
health care
CONCEPTS
 The nature of community health nursing
practice requires that current knowledge
derived fro the biological & social sciences,
ecology, clinical nursing & community
health organizations be utilized
 The dynamic process of assessing,
planning, implementing and intervening,
provide periodic measurements of progress,
evaluation and a continuum of the cycle
until the termination of nursing is implicit in
the practice of CHN
PRINCIPLES (Gardner, Leahy, Cobb, Jones)

 CHN is based on recognized needs of

communities, families, groups &
individuals
 The community health nurse must
understand fully the objectives & policies
of the agency she represents
 In CHN, the family is the unit of service
 CHN must be available to all regardless of
the race, creed & socio-economic status
 Health teaching is a primary responsibility
o the community health nurse
 The community health nurse works as a
member of the health team
 There must be provision for periodic
evaluation of community health nursing
services
 Opportunities for continuing staff education
programs for nurses must be provided by
the CHN agency. The nurse also has a
responsibility for his/her own professional
growth
 The community health nurse makes use
of available community health resources
 The nurse utilizes the already existing
active organized groups in the
community
 There must be provision for educative
supervision in CHN
 There should be accurate recording &
reporting in CHN
 GOALS
 To raise the level of health of the
citizenry
 Help communities and families to cope
with the discontinuities in health &
threats in such a way as to maximize
their potential for high level wellness
 Promote reciprocally supportive
relationship between people and their
physical and social environment
OBJECTIVES
 To participate in the development of an
over-all health plan for the community and
in its implementation & evaluation
 To provide quality nursing services to
individuals, families & communities utilizing
as basis, the standards set for the
community health nursing practice
 To coordinate nursing services with various
members of the health team, community
leaders and significant others
 To participate in and/or conduct
researches relevant to community
health and CHN services and
disseminate their results for
improvement of health care
 To provide community health
nursing personnel with opportunities
for continuing education and
professional growth through staff
development
HISTORICAL DEVELOPMENT
1901 ◼ Act No. 157 of the Phil.
Commission created a Board
of Health of the Philippines
which also acted as the Board
of Health for the City of
Manila.
◼ Subsequently, Act No. 309
created Provincial and
Municipal Boards of Health
1905 ◼ Act No. 1407 (Reorganization
Act) abolished the Board of
Health and its function and
activities were taken over by
the Bureau of Health under the
Department of Interior

1906 ◼ District Health Offices headed

by District Health Officers had
jurisdiction over health districts
 ◼ The Fajardo Act (Act No. 2156) created
1912 Sanitary Division. The President,
Sanitary Division (forerunners of the
present MHO) took charge of 2 or 3
municipalities. Where there were no
physicians available, male nurses were
assigned to perform the duties of the
President, Sanitary Division
◼ PGH, then under the Bureau of Health
sent 4 nurses to Cebu to take care of
mothers & their babies.
◼ St. Paul’s Hospital School of Nursing
(Intramuros) assigned 2 nurses to do
home visiting in Manila & gave nsg care
to mothers & newborn babies from the
OP obstetrical service of the PGH
1914 ◼ School nsg was rendered by a Filipino
nurse employed by the Bureau of
Health in Tacloban, Leyte
1915 ◼ Bureau of Health was renamed Phil.
Health Services with a Director of
Health as its Head. It was placed
under the Dept of Public Instruction
with the V-Gov Gen as the Dept.
Secretary
◼ Reorganization Act No. 2462 created
the Office of Gen. Inspection. The
Office of District Nursing was
organized under this Office and was
headed by a lady physician, Dr.
Rosario Pastor who was also a nurse
1915 ◼ 2 graduate Filipino nurses, Mrs.
Casilang Eustaquio and Mrs.
MAtilde Azurin were employed for
Maternal & Child Health &
Sanitation in Manila under an
American Nurse, Mrs. G.D.
Schudder

1916 - ◼ Ms. Perlita Clark took charge of the

1918 PHN work. Her staff was
composed of 1 American nurse
supervisor, 1 American dietitian,
36 Filipino nurses working in the
provinces & 1 nurse & 1 dietitian
assigned in 2 Sanitary Divisions
1917 ◼ 4 Graduate nurses paid by
the City of Manila were
employed to work in the
City Schools. Provinces that
could afford to carrry out
school health services were
encouraged to employ a
District Nurse

1918 ◼ The office of Ms Clark was

abolished due to lack of
funds
1919 ◼ The 1st Filipino nurse
supervisor under the Bureau
of Health, Ms Carmen del
Rosario was appointed. She
succeeded Ms. Mabel Dabbs
◼ She had a staff of 84 PN
assigned in 5 health
stations. There was a
gradual increase of PHN &
expansion of services.
1923 ◼ Establishment of 2 government
Schools of Nursing:
• Zamboanga General Hospital School
of Nursing
• Baguio General Hospital in Northern
Luzon
◼ These schools were primarily
intended to train non-Christian
women & prepare them to render
service among their people.
◼ In later years 4 more government
Schools of Nursing were established
• 1 in Southern Luzon (Quezon
Province)
• 3 in Visayan Islands of Cebu, Bohol
& Leyte
July 1, ◼ Ms. Carmen Leogardo resigned &
1926 Ms. Genara S.Manongdo, a
ranking supervisor of the
American Red Cross, Phil.
Chapter was appointed in her
place

1927 ◼ Office of District Nursing under

the Office of Gen. Inspection,
Phil. Health Service was
abolished and supplanted by the
Section of Public Health Nsg.
◼ Mrs. Genara de Guzman acted as
consultant to the Director of
Health on nsg matters
1928 ◼ 1st convention of nurses was
followed by yearly conventions
until the advent of WWII. Pre-
service training was initiated as a
pre-requisite for appointment
1930 ◼ Section of PHN was converted into
Section of Nsg d/t pressing need
for guidance not only in public nsg
services but also in hospital nsg
and nsg education
◼ The Section of Nsg was transferred
from the Office of General Services
to the Division of Administration
◼ This Office covered the supervision
& guidance of nurses in the
1933 ◼ Reorganization Act No. 4007
transferred the Div. of Maternal &
Child Health of the Office of Public
Welfare Commission to the Bureau of
Health
◼ Appointment of Mrs. Soledad A.
Buenafe, former Assistant
Superintendent of Nurses of the Public
Welfare Commission as Assistant
Chief Nurse of the Section of Nsg,
Bureau of Health
1940
◼ The Manila Health Dept was created
by virtue of the new charter of the
City of Manila
1941 ◼ Activities & personnel including 6
public health members of the
Metropolitan Div, Bureau of Health
were transferred to the new dept.
◼ Dr. Mariano Icasiano became the 1st
City Health Officer of Manila
◼ An Office of Nsg was organized with
Mrs. Vicenta C. Ponse as Chief Nurse
& Mrs. Rosario A. Ordiz as Assistant
Chief Nurse. They occupied these
positions until their retirement

Dec. 8, ◼ At the outbreak of WWII, public

1941 health nurses in Manila were
assigned to devastated areas to
attend to the sick & the wounded
June ◼ A group of public health nurses
1942 with physicians & administrators
of the Manila Health Dept went
to the internment camp in
Capas, Tarlac to receive sick
prisoners of war released by the
Japanese army

◼ They were confined at San

Lazaro Hospital & 68 National
PHN were assigned to help the
hospital staff to take care of
them
July ◼ 31 nurses who were taken prisoners of
1942 war by the Japanese army and confined
at the Bilibid Prison in Manila were
released to the then Director of the
Bureau of Health, Dr. Eusebio Aguilar
who acted as their guarantor

Feb ◼ Post war records of the Bureau of

1946 Health showed that there were 308
public health nurses and 38 supervisors
compared to pre-war when there were
556 PHN and 38 supervisors
◼ Mrs. Genara M. de Guzman,Technical
Assistant in Nursing of the DOH &
concurrent President of the Filipino
Nurses Association recommended the
 ◼ Executive Order No. 94 reorganized
◼ Oct. 7,
government offices & created the
1947
Division of Nsg under the Office of
the Secretary of Health (Dec. 16,
1947)
◼ Mrs.Genara de Guzman was
appointed as Chief of the Division
with 3 assistants:
◼ Nursing Education – Ms. Annie Sand
◼ PHN – Mrs. Magdalena C.Valenzuela
◼ Staff Education – Mrs. Patrocinio J.
Montellano
◼ The Nursing Division was placed
directly under the Secretary of
Health so that nsg services can be
◼ At the Bureau of Health, the
Section of Nsg Supervision took
over the functions of the former
Section of Nsg.
◼ Mrs. Soledad Buenafe was
appointed Chief and Ms.
Marcela Gabatin, Assistant
Chief
◼ The newly created Section of
Puericulture Center of the
Bureau of Hospitals had Ms.
Teresa Malgapo as Chief
1948 ◼ The 1st training center of the BOH was
organized with the cooperation of the Pasay
City Health Dept.
◼ Tabon Health Center & renamed Dona Marta
Health Center
◼ Preservice & In-service training in public
health/PHN as well as nsg students
affiliation
◼ Training Staff:
• Center Physician – Dr. Trinidad A. Gomez
• Nurse Supervisor – Ms. Marcela Gabatin
• Nat’l PHN – Ms. Zenaida Y. Panlilio
• Nurse Instructors:
◼ Ms. Constancia Tuazon

◼ Mrs. Bugarin

◼ Ms. Ramos
 ◼ Organization of Rural Health
◼ 1950 Demonstration & Training Center
(RHDTC) by the DOH
◼ Trough the initiative of Dr. Hilario
Lara, Dean Institute of Hygiene (now
College of Public Health, UP)
◼ Assisted by WHO/UNICEF
◼ It was used as a laboratory for the
field experiences of graduate & basic
students in medicine, nsg, health
education, nutrition & social service
◼ Chief: Dr. Amancia S. Mangay (Mrs.
Andres Angara) Doctor of PH
graduate from Harvard
◼ Medical Training Officer: Dr. Antonio
N. Acosta
1953 ◼ Creation of the Office of Health
Education and Personnel Training
◼ Chief: Dr. Trinidad Gomez
◼ 4 Nurse Instructors:
• Mrs. Venancia Ramos
• Mrs. Damasa Torrejon
• Ms. Zenaida Y. Panlilio
• Ms. Leonora M. Liwanag
◼ Philippine Congress approved RA
No. 1082 – Rural Health Law.
• It create the 1st 81 RHUs
• Each had a physician, a PHN, a
midwife, a sanitary inspector, & a clerk
driver
• Provided with jeep by the UNICEF
1957 ◼ Approval of RA 1891 which
amended sections 2, 3, 4, 7,
& 8 of Republic Act 1082
“Strengthening Health &
Dental Services in the
Rural Areas & Providing
Funds Thereto”
• 2nd Rural Health Act
• Created 8 categories of RHUs
based on population
• Resulted in additional numbers
of position for health workers
1958 - ◼ Implementation of RA 977 which was
1965 passed by Congress in 1954
◼ Abolished the Division of Nursing
◼ Created nursing positions at different
levels
◼ Ms. Annie Sand – Nursing Consultant
◼ DOH National League of Nurses, Inc.
was founded by Ms. Annie Sand (1961)
– 1st President & Adviser
◼ The Reorganization Act with
implementing details embodied in EO
288, series of 1959 decentralized &
integrated health services
• It created 8 Regional Health Offices in
the country, increased to 11 ten to 16
◼ At the Regional level:
• 3-4 Regional Nurse Supervisors
• 1-2 Regional PHNs
◼ Each had a Regional Training Center
◼ The Reorganization of 1959 merged 2
Bureaus in DOH: - Bureau of Health
& Medical Services
• Bureau of Health
◼ MCH
◼ Dental Health
◼ Industrial or Occupational Health
• Bureau of Hospitals
◼ Curative programs and regulatory/licensing
functions
 1967
◼ Bureau of Disease Control
• Nursing Program Supervisor &
consultant: Mrs. Zenaida Panlilio-Nisce
• 6 special dse: TB, Leprosy, VD, Cancer,
Filariasis, & Mental Health
◼ Office of Health Education &
Personnel Training
• Nurse Instructors were involved in staff
development & training of foreign &
local health workers
• Positions were reclassified as Dept.
Training Nurses
 November 1971
◼ MRS. JOSEFINA A.MENDOZA
• Supervising Nurse Instructor
• Succeeded Ms. Annie Sand as
Nursing Consultant
◼ MRS.NILDA K.CASTILLO
• Appointed as Nursing Supervisor,
Office of the Secretary of Health
◼ MS. HELEN FILLMORE
• WHO Consultant on Pediatric
Nursing
 1974
◼ The Project Management
Staff was organized as
part of the Population Loan
II of the Phil. Gov.
◼ Dr. Francisco Aguilar –
Project Manager
 1976-1986
◼ The Nursing Consultant and Nursing
Program Supervisor were involved in
the Rural health Practice Program
• Required medical & nsg graduates to serve 2
months in the rural areas before their license
was issued by PRC
• It stopped when the number of nsg
graduates reached 12,000/annum
◼ Pres. Ferdinand Marcos
• Mrs. Mendoza strongly & repeatedly
recommended the creation of a Bureau of
Nursing but were not materialized
 1986
◼ Reorganization off the DOH which
placed Nursing Consultant at the
Bureau of Health & Medical Services
◼ Was later abolished
◼ Mrs. Mendoza retired on May 1, 1986
◼ Mrs. Zenaida Nisce was made
Secretary, Task Force on Mental
Health
◼ National Family Planning Service
(NFPS)
 1987 - 1989
◼ EO No. 119
•REORGANIZED THE DOH
AND CREATED SEVERAL
OFFICES AND SERVICES
WIHTIN THE DOH
 1990 - 1992
◼ Increase in the number of positions of
Nursing Program Supervisors (Nurse VI)
◼ Other programs: EPI, CDD, CARI
◼ Non-Communicable Disease Control
Service (NCDCS)
• CVDs, cancer, diabetes, blindness, deafness,
osteoporosis, asthma, smoking control programs
◼ Communicable Disease Control Service
• Leprosy, STDs, HIV/AIDS Prevention & Control
Unit, rabies, filariasis, dengue hemorrhagic fever
◼ Community Health Service
◼ DOH Administrative Service
 1990-1992
◼ LOCAL GOVERNMENT CODE of
1991 ( RA 7160)
◼ DEVOLUTION
• It transferred the power and
authority from the national to the
LGUs.
• It was aimed to build their
capabilities for self-government &
develop them fully as self-reliant
communities
 1993 - 1998
◼ THE NATIONAL LEAGUE OF
NURSES, INC.
• Organization of government nurses
• Made repeated representations
with the Incumbent Secretary of
Health to create an Office of
Nursing
• Position papers were submitted
from time to time but were not
given priority
 JANUARY 1999
◼ DEPARTMENT ORDER NO. 29
•Designated Mrs. Nelia F. Hizon,
Nurse VI as Nursing Adviser
•She was detailed at the Office
of Public Health Services with
Undersecretary Milagros
Fernandez as Chief
 MAY 24, 1999
◼ EXECUTIVE ORDER NO. 102
was signed by Pres. Joseph
Ejercito Estada
• Redirecting the functions and
operations of the DOH
• Most of the nursing positions at the
Central Office were either
transferred or devolved to other
offices and services
 2005 - 2006
◼ The development of the
RATIONALIZATION
PLAN to streamline the
bureaucracy further was
started and is in the last
stages of finalization