Professional Documents
Culture Documents
NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
The DOH provides guidance and technical
assistance to LGUs through the Center for Health
HEALTH CARE DELIVERY Development in each of the 17 regions.
SYSTEM
Provincial government is responsible
for administration of provincial and
A nation’s health care delivery system has strict hospitals.
a tremendous impact not only on the health Municipal and city governments are in
of its people but also on their total charge of primary care through rural
development, including their health units (RHUs) or health centers.
socioeconomic status.
A discussion of the health care delivery
system often involves issues of cost and
challenges.
Nations go through a struggle to overcome Satellite outposts known as barangay
multiple forces in efforts to advance the health stations (BHSs) provide health
nation’s health within the context of their services in the periphery of the
financial and political situations. municipality or city.
The nurse is an essential member of the
health workforce in the country. For the As mentioned earlier, the Local
nurse to work efficiently within the health Government Code mandated the
care delivery system, an understanding of devolution or decentralization of basic
the dynamic relationships among its health services.
components is needed.
Anderson and Mc Earlane (2011) This means that LGUs have the
emphasized the role of the following autonomy and responsibility to plan
factors in shaping 21st century health that and implement basic health services
further influence health care delivery (primary care) on behalf of their
system: constituents.
This is a mandate for LGUs
FACTORS THAT INFLUENCE HEALTH Depending on the capability and
CARE DELIVERY SYSTEM political will of the municipality /city
government, higher levels of services
Health care reforms may be provided.
Demographics Thus, it is possible for a city or
Globalization municipality to administer a
Poverty and growing disparities secondary or even a tertiary hospital.
Social disintegration
- For example: Ospital ng Maynila
The DOH serves as the main governing body of Medical Center is tertiary
health services in the country. hospitals, is funded by the city
government of Manila.
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
Government - In the Philippines health
Private sector- for profit and care system is complex set
nonprofit agencies. of organizations interacting
to provide an array of
- On the National level, direction is health services.
set by the Department of Health
(DOH) . By virtue of the mandate Components of the Health Care Delivery
of the local Government Code System as mandate of the Department of
(R.A. 7160), local government Health (DOH) is to be responsible for the
units (LGUs) should have an following
operating mechanism to meet the
priority needs and service formulation and development of
requirements of their national health policies, guidelines,
communities. standards
- This sector provides all levels of manual of operations for health
services and accounts for a large services and programs;
segment of health service issuance of rules and regulations,
providers in the country. licenses and accreditations;
- About 30% of Filipinos utilize promulgation of national health
private health facilities. standards, goals, priorities and
- An estimated 60% of the national indicators;
health expenditure goes to the development of special health
private sectors. programs and projects and advocacy
- This sector also employs more for legislation on health policies and
than 70% of the health programs.
professionals in the Philippines
Romualdez, 2011) The Primary Function of the Department of
Health:
promotion
Financing of health services is provided by
protection
three major groups
preservation
Government (national and restoration of the health of the people
local) through the provision and delivery of
Private sources health services and through the
Social health insurance regulation and encouragement of
- National Health Insurance providers of health goods and services
Act of 1995 (R.A. 7875) (E.O. No. 119, Sec.
created the Philippine
Health Insurance
Corporation (PhilHealth).
It is a tax-exempt HEALTH CARE DELIVERY SYSTEM
government corporation It is the totality of all policies,
attached to the DOH for infrastructures, facilities, equipment,
policy coordination and products, human resources, and
guidance, and aims for services that addresses the health
universal health coverage needs, problems and concerns of all
of all Filipino citizen. people.
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
rendering health care services to the Health System has 6 building blocks or
components
people.
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
partnerships where joint action is September 6-8, 2000- Millennium
needed. Summit. World leaders in the UN
Shaping the research agenda and assembly participated.
stimulating the generation, translation
and disseminating valuable knowledge United Nations Millennium
Declaration. The world leaders
WHO strategy on research has 5 goals recognized their collective
responsibility to uphold the principles
Capacity in reference to capacity of human dignity, equality, and equity
building to strengthen national health at the global level.
research systems
Priorities to focus research on priority
The declaration expressed the
health needs particularly in low-and
commitment of the member states is
middle-income countries
to reduce poverty and achieve the 7
Standards to promote good research
other targets. Now called Millennium
practice and enable the greater sharing
Development Goals (MDGs) by the
of research evidence tools, and
year 2015.
materials
Translation to ensure that quality
evidence is turned into products and MILLENNIUM DEVELOPMENT GOALS
policy Eradicate extreme poverty and
Organization to strengthen the hunger
research culture within WHO and Achieve universal primary
improve the management and education
coordination of WHO research Promote gender equality and
activities empower women
Reduce child mortality
Setting norms and standards and promoting Improve maternal health-mmr n
and monitoring their implementations. rh
Articulating ethical and evidence-based Combat HIV/AID, malaria and
policy options. other diseases
Ensure environmental
Proving technical support, catalyzing sustainability
change, and building sustainable Develop a global partnership for
institutional capacity development
In the past decade, WHO has worked
as a partner of the Philippine DOH in SUSTAINABLE DEVELOPMENT GOALS
the development and provision of
services towards the attainment of Known as the Global Goals are a universal
health-related Millennium are a collection of 17 global goals set by
Development Goals (MDGs). the United Nations
Assembly in 2015 for the year 2030. The
THE MILLINEUM DEVELOPMENT SDGs are part of Resolution 701 of the
GOALS United Nations General Assembly
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They are the blueprint to achieve a better competitive and responsive health care
and more sustainable future for all. They system, and equitable health financing.
address the global challenges we face, Mission: statement is to guarantee
including those related to poverty, equitable, sustainable, and quality health
inequality, climate, environmental for all Filipinos, especially the poor, and to
degradation, prosperity, and peace and lead the quest for excellence in health. .
justice. (DOH, 2012b)
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REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
Ensure accessibility and quality of
As administrator of specific services, the DOH health care to improve the quality of
is tasked to life of all Filipinos
Vision
Pre-Spanish and Spanish period (before 1898)
HEALTH FOR ALL BY 2000 & HEALTH IN
Traditional health care practices especially
THE HANDS OF THE PEOPLE BY 2020.
the use of herbs and rituals for healing
THE DOH is the leader, staunch were widely practiced during these
advocate and model in promoting periods.
“Health for all in the Philippines . The western concept of public health
Mission services in the country is traced to the first
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
dispensary for indigent patients of Manila 1912
ran by a Franciscan friar that was began in -Act No. 2156 known as the Fajardo Act,
1577. consolidated the municipalities into sanitary
In 1876 Medicos Titulares, equivalent to divisions and established what is known as the
provincial health officers were already Health Fund for travel and salaries.
existing in 1888, a Superior Board of
Health and Charity was created by the
1915
Spaniards which established a hospital
system and a board of vaccination among Act No. 2468 transformed the Bureau of
others. Health into a commissioned service called
the Philippine Health Service.
June 23, 1898
This introduced a systematic organization
Shortly after the proclamation of the of personnel with corresponding civil
Philippine independence from Spain, the service grades and a secure system of civil
Department of Public Works, Education service entrance and promotion described
and Hygiene was created by virtue of a as the “semi-military system of public
decree signed by President Emilio health administration.
Aguinaldo.
August 2, 1916
September 29, 1898 The passage of the Jones Law also known
With the primary objective of protecting as the Philippine Autonomy Act, provided
the health of the American soldiers the highlight in the struggle of the
General Orders No. 15 established the Filipinos for Independence from the
Board of Health for the City of Manila. American rule.
The establishment of an elective Philippine
July 1,1901 Senate completed an all-Filipino
A Board of Health for the Philippine Philippine Assembly that formed a
Islands was created through Act No. 157. bicameral system of government.
This also functioned as the local health This ushered in a major reorganization
board of manila. It truly became an Insular which culminated in the administrative
Board of Health when Act Nos 307,308 Code of 1917 (Act 2711) which included
dated Dec. 2, 1901, established the the Public Health Laws of 1917
Provincial and Municipal Boards
respectively completing the health 1932
organization in accordance with the Because of the need to better coordinated
territorial division of the islands. public health and welfare services, Act No.
4007 known as the
October 26, 1905 Reorganization Act of 1932, reverted back
The Insular Board of Health proved to be the Philippine Service into the Bureau of
inefficient operationally so it was Health, and combined the
abolished and was replaced by the Bureau Bureau of Public Welfare under the Office
of Health under the Department of Interior of the Commissioner of the Health and
through Act No. 1407. Act No. 1487 in Public Welfare
1906 replaced the provincial boards of
health with district health officers 1935-1945
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
The Philippine Commonwealth and the Maternal and child health, environmental
Japanese Occupation health, communicable disease control, vital
statistics, medical care, health education
May 31, 1939 and public health nursing.
This was carried out in 81 selected
Commonwealth Act No. 430 created the
provinces. The impact to the community
Department of Public Health and Welfare
was strong. It directly resulted in the
but the full implementation was only
passage of the Rural health Act of 1954
completed through Executive Order No.
(RA 1082). This Act created more rural
317, January 7,1941. Dr. Jose Fabella
health unites and crated posts for
became the first Department Secretary of
municipal health officers among other
Health and Public Welfare in 1941.
provisions.
February 20,1958
1942
Executive Order No. 288 provided for
what is described as the” most sweeping”
During the period of the Japanese reorganization in the history of the
occupation, various reorganization and department at that period.
issuances for the health and welfare of the This came about an effort to decentralize
people were instituted and lasted until the governance of health services.AN Office
Americans came in 1945 and liberated the of the Regional Health Director was
Philippines. created in 8 regions and all health services
were decentralized to the regional,
October 4, 1947 provincial and municipal levels. Bureaus
Executive Order No. 94 provided for the were limited to staff functions such as
post war reorganization of the Department policy making and development of
of Health and public Welfare. procedures.
This resulted in the split of the Department RHUs were made as integral part of the
with transfer of the Bureau of Public public health care delivery system.
Welfare (which became the Social Welfare 1970
administration) and the Philippine General The Restructured Health V=Care Delivery
Hospital to the Office of the President. System was conceptualized. It classified
Another was created between the curative health services into primary, secondary,
and preventive services through the and tertiary levels of care.
creation of the Bureau of Hospitals which
took over the curative services. This further expanded the reach of the
Preventive care services remained under rural health units. Under this concept the
the Bureau of Health. This order also public health nurse to population ratio was
established the Nursing Service Division 1:20,000.
under the Office of the Secretary. The expanded role of the public health
nurse was highlighted.
January 1, 1951
The office of the President of the Sanitary June 2,1978
District was converted into a public health
Unit, carrying out 7 basic health services:
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
With proclamation of martial law in the
country, {residential Decree 1397 renamed
the Department of Health to the Ministry
of Health. Secretary Gatmaitan became the
first Minister of Health.
Under this law, all structures personnel
December 2,1982 and budgetary allocations from the
Executive Order No. 851 signed be the provincial health level down to the
President Ferdinand E. Marcos barangays were devolved to the local
reorganized the Ministry of Health as an government units (LGUs) to facilitate
integrated health care delivery system health service delivery. The department of
through the creation of the Integrated Health changed its role from one of
Provincial Health Office which combines implementation to one of governance
public health and hospital operations under
the Provincial Health Officers.
May 24, 1999
Executive Order No. 102 “Redirecting the
April 13, 1987 Functions and Operations of the
Executive Order No.119 “Reorganizing Department of Health” by President
the Ministry of Health “by President Joseph E. Estrada granted the DOH to
Corazon C. Aquino saw a major change in proceed with its Rationalization and
the structure of the ministry. It transformed Streamlining Plan which prescribed the
the Ministry of Health back to the current organizational, staffing and
Department of Health. resource structure consistent with its new
mandate, roles and functions post
EO 119 devolution.
clustered agencies and programs under the
Office for Public Health Services, Office EO 102
for Hospital and Facilities Services. mandates the Department of Health to
The Field Offices were composed of the provide assistance to local government
Regional Health officers and National units, people’s organization and other
Health facilities. members of civic society in effectively
- The latter was composed implementing programs, projects and
of National Medical services that will promote the health and
centers, the Special well-being of every Filipino; prevent and
Research Centers and control diseases among population at risks,
Hospitals. Five Deputy protect individuals, families and
minister positions were communities exposed to hazards and risks
also created. that could affect their health and treat ,
October 10,1991 manage and rehabilitate individuals
Republic Act 7160 known as the Local affected diseases and disability.
Government Code provided for the
decentralization of the entire government. 1994-2004
This brought about a major shift in the role Development of the Health Sector Reform
and functions of the Department of Health. Agenda which describes the major
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
strategies, organizational and policy health care services, new centers of
changes and public investments needed to authority for local health services emerged.
improve the way health care is delivered, These consist of provincial, city, municipal
regulated and financed. governments, including an autonomous
regional government and a metropolitan
2005 ongoing authority.
Each center controls a portion of the health
Development of a plan to rationalize the
care system as part of its political and
bureaucracy in an attempt to scale down
administrative mandate. Now, provincial
including the Department of Health.
governments operate the hospital system.
Provincial and District Hospitals, while
LOCAL HEALTH SYSTEM and city. -Municipal governments operate the
DEVOLUTION of HEALTH SERVICES Health Centers (HC) /Rural Health Units
(RHU) and Barangay Health Stations.
Historical background One of the most significant laws that
radically changed the landscape of health
care delivery system in the country is RA
For over forty years after post war
7160 or commonly known as Local
independence, the Philippine health care
Government Code.
system was administered by a central
agency based in Manila.
This control system was agency provided
the singular sources, policy direction,
technical and administrative supervision to
all health facilities nationwide.
In 1991 the Philippines Government
introduced a major devolution of national
government services, which included the
first wave of health sector reform, through
the introduction of the Local Government
Code of 1991, known as Republic Act
7160.
The Code devolved basic services for
agriculture extension, forest management,
health services, barangay (township) roads
and social welfare to Local Government
Units.
In 1992, the Philippines Government
devolved the management and delivery of
health services from the National
Department of Health to locally elected
provincial, city and municipal
governments.
Devolution made local government
executives responsible to operate local
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GOVERNOR
PROVINCIAL HEALTH
PROVINCIAL HEALTH
PROVINCIAL DISTRICT
OTHER HEALTH
HSOPITAL
HOSPITAL AND MEDICAL
FACILITIES
MUNICIPAL HEALTH
OFFICE
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
OFFICE OF THE
MAYOR
MUNICIPAL HRALTH
BOARD
MUNICIPAL HEALTH
OFFICE
RURAL HEALTH
BARANGAY HEALTH
UIT/HEALTH CENTER
STATION
Each province, city and municipality have a local Health Board (LHB).
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FAR EASTERN UNIVERSITY – DR. NICANOR
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
This body is a good venue for making the local health system more responsive to the needs of the
people. It is mandated to propose annual budgetary allocations for the operation and maintenance of
health facilities and services within the municipality, city or province.
At the provincial level, it is composed of the governor (chair), provincial health officer (Vice chair),
chairman of the Committee on Health of the Sanggunian Panlalawigan, DOH representative and
NGO representative.
At the city and municipal level, the LHB is composed of the Committee on health of the Sanggunian
Bayan, DOH representative and NGO representative
At the municipal level, many public health nurses have been appointed as DOH representative. This
means that they have been retained by the DOH.
Many of them however dual functions-those of a public nurse and those of a DOH representative.
Many of the local government units “cannot afford” to hire a replacement.
The DOH has allowed this set up as a form of a support to low-income municipalities
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
The shift in the leadership in health care from the national government to the LGUs has resulted in
both the improvement and deterioration of health care delivery.
There are LGUs that are committed to health and are innovative while they are those that re just
interested in the purchase of supplies and medicines,
Some LGUs have the financial capability to support their own health care delivery system while
others do not have adequate financial resources.
It has been established that an LGUs financial capability, a dynamic and responsive political
leadership and community empowerment are the important ingredients of an effective local health
system.
DOH issued Administrative Order 2012-0012 that provides for a new classification of health
facility. -DOH Administrative Order 2012-0012(Rules and Regulations Governing the New
Classification of Hospitals and Other Health Facilities in the Philippines).
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
A health facility that provides long term care, including basic services like food and shelter, to patients with
chronic conditions requiring ongoing health and nursing care due to impairment and a reduced degree of
independence in activities of daily living and patients in need of rehabilitation
-Examples: are custodial psychiatric facilities, substance. drug abuse treatment and rehabilitation centers,
sanitaria/ leprosaria and nursing homes
The test covers the pre analytical, analytical and post analytical
Radiologic facility providing services such as X-ray, CT scan, mammography, MRI, and
ultrasonography 3. Nuclear medicine facility- a facility regulated by the Philippine Nuclear Research
Institute utilizing applications of radioactive materials in diagnosis, treatment or medical research,
with the exception of the use of sealed radiation sources in radiotherapy as in internal radiation
therapy
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
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FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system with the
values of Equity, Quality, Efficiency, Transparency, Accountability, Sustainability, Resilience
towards “Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat”.
Briefly History
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FAR EASTERN UNIVERSITY – DR. NICANOR
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
development workers for the protection and such as thenvironment, education, social
promotion of health of all the people. services and politics/ leadership.
Legal Basis of PHC in the Philippines A healthy population has the capability to
contribute more to its development. By
Letter of instruction (LOI) 949 signed by emphasizing the people’s right to health,
Pres. Marcos on October 19, 1979. the government is driven to increase
Making the Philippines the first country in investment on health care.
Asia to embark on meeting the challenge The WHO recommends governments to
of PHC. allocate 5% of the gross national product
It must be noted that even prior to LOI (GNP) to health services from 2005 to
949, which provided impetus to the then 2007 was only 3.3 % of the GNP
Ministry of Health, there were several
health workers, nongovernmental 5 A’s (4As)
organizations (NGOs) and church
organizations offering community-based
Accessible
health programs in the rural areas of
Visayas and Mindanao, applying the spirit The WHO guideline states that for these
of PHC even before it was formally health care facilities to be considered
adopted by the government. accessible, they must be within 30
The Alma ATA Declaration on Primary minutes from the communities. BHSs are
Health Care emerged from this conference. facilities intended to provide accessible
The Alma Ata conference made the health services at the community level.
following declarations
Health is a basic fundamental right Attainable
There exists global burden of health
inequalities among populations Affordable
Economic and social development is of
is not only in consideration of the
basic importance for the full attainment of
individual or family’s capacity to pay for
health for all 4. Governments have a basic health services.
responsibility for the health of their
people.
Particularly for public health services, it is
Basic to the PHC declaration is the
common view that health “is a state of also a matter of whether the community or
complete, physical, mental, and social government can afford these services. One
well-being, and not merely the absence of of the factors the WHO considers in
disease or infirmary “ determining affordability of health care is
the out of pocket expenses for health care.
Viewing health from holistic perspective,
This is the actual cost to the family for
beyond just physical and mental maladies,
health services lea any coverage of
the WHO has put equal emphasis on the
insurance. In the Philippines, the
social dimensions of health, that wellness
government health insurance is covered
can be achieved by considering different
through Phil health.
factors that interdependently influence the
health of the population,
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FAR EASTERN UNIVERSITY – DR. NICANOR
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
There are other health insurance policies The universal goal of PHC as stated in
offered by private companies or health the Alma ATA Declaration is “Health for
management organization. all” by the year 2000. -Health for all
means an acceptable level of health for
Acceptable all the people of the world through
community and individual self-reliance.
means that the health care offered in in
consonance with the prevailing culture and This policy agenda of “health for all by the
traditions of the population. year 2000” technically was a global
strategy employed for achieving their main
Availability objectives.
is a question of whether the basic health
services require by the people are offered
in the health care facilities or id provided Main Objectives
on a regular and organized manner. Promotion of healthy lifestyles
Prevention of diseases
PHC as a service delivery policy of the Therapy for existing conditions
DOH permeates all strategies and thrusts President Marcos signed the LOI 949 that
of government health programs from the has an underlying theme” Health in the
national to the local and community levels Hands of the People by 2020”
PHC is a complete turn-about from
disease-oriented, curative, hospital based, 5. 5 key ELEMENTS
and urban centered health care to
preventive, people centered, and
The WHO has identified 5 key elements to
community-based health care.
achieving the goal “health for all”
- Reducing exclusion and social disparities
The WHO defined PHC: in health (universal coverage)
- Organizing health services around
Essential health care made universally people’s needs and expectations (health
accessible to individuals and families in service reforms)
the community by means acceptable to - Integrating health into all sectors (public
them, through their full participation and policy reforms)
at a cost that the community and country - 4, Pursuing collaborative models of policy
can afford at every stage of development. dialogue (leadership reforms)
- Increasing stakeholder participation
According to Alma Ata Declaration, PHC
“is essential health care based on practical, The Alma Ata Declaration listed 8 essential
scientifically sound and socially health services using the ACRONYM
acceptable methods and technology made (ELEMENTS)
universally accessible to individuals and
families in the community through their
E-education for all
full participation and at a cost to maintain
at every stage of their development in the L Locally endemic disease control
spirit of self-reliance and self- E expanded Program for immunization
determination”
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
M maternal and child health including responsible Relates to activities directed at preventing a
parenthood problem before it occurs by altering susceptibility
E essential drugs or reducing exposure for susceptible individuals.
N nutrition Health promotion efforts enhance resiliency and
T treatment of communicable and non- protective factors and target essentially well
communicable diseases population.
S safe water and sanitation
2 Elements
Principles of PHC AND STRATEGIES General health promotion
Specific protection
Accessibility, affordability, acceptability Example of primary prevention: Promotion of
and availability good nutrition, provision of adequate shelter and
Support mechanism encouraging regular exercise
Multisectoral approach Specific protection efforts
Community participation Reduce or eliminate risk factors and
Equitable distribution of health resources include such measures as immunization,
Appropriate technology and water purification.
SECONDARY PREVENTION
Refers to early detection and prompt
Health programs according to the 4As intervention during the period of early
Botika ng Bayan and the Botika ng disease pathogenesis.
barangay It was implemented after a problem has
Ligtas sa Tigdas ang Pinas” mass measles just begun but before signs and symptoms
immunization campaign. Children aged 9 appear and target those population who
months to below 8 years old. The two have risk factors
were vaccinated against measles and Example: Mammography, Blood pressure
rubella screening, newborn screening and mass
sputum examination for pulmonary
tuberculosis
LEVELS OF PREVENTION
Secondary prevention is also directed
Health promotion activities enhance resources toward prompt intervention to prevent
directed at improving well-being. worsening conditions of the affected
Disease prevention activities protect people from population.
disease and the effects of disease. This includes measures during the early
stage of disease to prevent complications.
3 Levels of Prevention Teaching how to Oresol to her child
Primary Prevention suffering from diarrhea to prevent
Secondary Prevention dehydration and administering vitamin A
Tertiary Prevention capsules to children with measles.
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FAR EASTERN UNIVERSITY – DR. NICANOR
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COMMUNITY HEALTH NURSING LECTURE (NCM 104)
Targets population that have experienced
disease or injury and focuses on limitation
of disability and rehabilitation.
Aims of tertiary prevention are to reduce
the effects of disease and injury and to
restore individuals to their optimal level of
functioning.
Examples: Teaching how to perform
insulin injection techniques and disease
management to a patient with diabetes,
referring a patient with spinal injury for
occupational and physical therapy and
leading a support group for cancer patients
who have undergone cancer treatment such
as surgery, chemotherapy and radiation
therapy.
EXAMPLES OF LEVELS
CABINGAO,B
BSN-2A
FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
• LEVEL OF PREVENTION
DEFINITION OF Primary (health Secondary (early Tertiary (limitation of disability and
CLIENT SERVED* promotion and diagnosis and rehabilitation)
specific prevention) treatment)
Individual Dietary teaching HIV testing Teaching new clients with diabetes
during Screening for to administer insulin
pregnancy cervical cancer Exercise therapy after stroke
Immunizations
Family (two or more Education or Dental examination Skin care for incontinent patients
individuals bound by counseling regarding Diabetes screening Mental health counseling or referral
kinship, law, or living smoking, dental for family at risk for family in crisis (grieving or
arrangement and with care, or nutrition experiencing a marital conflict)
common emotional Adequate housing
ties and obligations)
Mothers’ class on Vision screening of Dietary instructions and monitoring
breastfeeding first- for family
Education for drug grade class Mass with overweight
abuse prevention for sputum members
high school students examination in a Group counseling for grade school
lowincome children with asthma
neighborhood Exercise program for diabetics at a
Hearing tests at a center for the elderly
center for the elderly
Community and Fluoride water Organized screening Alcoholics Anonymous and other
population (aggregate supplementation programs for self-help
of people sharing Environmental communities (e.g., groups
space over time sanitation Removal health fairs) Mental health services for military
within a social of VRDL screening for veterans Shelter and relocation
system; population environmental marriage license centers for fire, typhoon, or
hazards applicants in a city earthquake victims Emergency
groups or aggregates
medical services
with power relations
Community mental health services
and common needs or for chronically mentally ill Home
purposes) care services for
chronically ill
CABINGAO,B
BSN-2A
FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
CABINGAO,B
BSN-2A
FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
CABINGAO,B
BSN-2A
FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
-As a patient, that means that if you’re 3. PhilHealth will become the “national
admitted in a hospital, you can expect purchaser” of health goods and services
regular meals, a bed in a shared room with
fan ventilation, and a shared toilet and bath This means that PhilHealth will be in
to be covered. charge of paying health care providers like
All are also entitled to an “essential hospitals and clinics for services given to
health benefit package,” which Filipinos.
includes primary care, medicines, This is already a job PhilHealth carries out
diagnostic, and laboratory tests. It but the universal health care law wants to
also includes preventive, curative, pool more funds so it can cover all
and rehabilitative services. -It will Filipinos and eventually, more services.
no longer be free when one wants to Allocating more funds to PhilHealth will
stay in a hospital room offering also strengthen its negotiating power with
private accommodation, air health care providers, which will
conditioning, telephone, television, foreseeably improve the quality of services
and meal choices, among others. and lower health costs.
-Meanwhile, public and private hospitals Funds for PhilHealth will be sourced from
are expected to allocate a certain portion the following:
of their beds as basic accommodations in Philippine Amusement and Gaming
the following amounts: Corporation – 50% of national
-Government hospitals – at least 90% of government’s share
beds Philippine Charity Sweepstakes Office
-Specialty hospitals – at least 70% of beds (PCSO) – 40% of its charity fund, net of
-Private hospitals – at least 10% of beds document stamp tax payments, and
The law also states that if the patients mandatory PCSO contributions
need to pay for extra expenses, their “co- Premium contributions of direct
payment or what is paid on top of basic contributory members
services should be regulated by the DOH
in public hospitals By giving PhilHealth more funds, a goal of
This means that you should know what to the UHC is to make PhilHealth the
expect in terms of bills, as opposed to national purchaser of medicines. -This can
being shocked after treatment lower the cost of medicines as these will
Aside from this, current case rates or be bought in bulk.
packages PhilHealth has crafted for certain Another goal is to have quality of health
diseases will remain. -But together with services improve as PhilHealth can set as a
the DOH, PhilHealth is expected to work requirement for payment and contracting,
towards including more needs a person standards for health care providers.
may have for a disease in its case rates.
The two agencies are also expected to craft
and implement outpatient benefit services
to be covered by the National Health
Insurance Programs within 2 years after
the law takes effect.
CABINGAO,B
BSN-2A
FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
4. DOH will still be in charge of “population- Provincial and city health boards will be in
based” health services charge of pooling and managing a special
health fund to finance and improve health
While PhilHealth, along with other private services for residents. PhilHealth’s income
health insurance companies, is expected to will also be channeled to this special
cover services for individuals, the DOH is health fund.
still in charge of delivering health services
that cover entire populations. 6. Return service in the public health sector
Think of these as programs for disease
surveillance, health promotion campaigns, Graduates of health and health-related
and mass immunization campaigns. courses who received government-funded
The DOH will do this by contracting scholarships will be required to work in
public health care providers in cities and the public health sector for at least 3 full
provinces. years. This will address the need for health
workers across the country.
5. Health systems will become city-wide and They will be paid by and under the
province-wide supervision of the DOH. Those who serve
for an extra two years will also be given
Provinces and highly urbanized cities will incentives, which will be determined by
now be in charge of overseeing health the DOH.
services in areas as opposed to the current Meanwhile, graduates of health courses in
set-up where municipalities are tasked state universities and colleges and private
with managing their own health centers. schools are encouraged to work in the
public sector.
The DOH will need to work with the
Department of the Interior and Local 7. A “Health Technology and Assessment
Government (DILG) to have province- and Council” (HTAC) will be created
city-wide health systems or networks in
about two years after the law takes effect. Another important feature of the law is the
For this, one can imagine as an example, creation of the HTAC – a group of health
Rizal overseeing its province-wide health experts who will be responsible for
care network of clinics and hospitals evaluating latest health developments and
compared to each municipality in Rizal recommending their use to DOH and
taking care of its own health center alone. PhilHealth. -The HTAC will be
Similarly, highly urbanized cities like responsible for assessing the safety and
Cebu or Makati will oversee their own effectiveness of health technology,
health care network compared to single devices, medicines, vaccines, health
barangays being in charge of a health procedures, and other health-related
center. advances developed to solve health
Having access to health networks problems.
province-wide can address the problem of Reviewing the social, economic, and
inadequate access to health services due to ethical issues when using these
lack of funds in barangays or technologies or programs is also required.
municipalities.
CABINGAO,B
BSN-2A
FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
The HTAC will be attached to the DOH BACKGROUND AND RATIONALE
for the first 5 years after the law is
implemented. After this, it will become an RATIONALE:
independent body attached to the
Department of Science and Technology. Health sector reforms are intended to bring
about equity in health care delivery.
8. Health information will be collected Survey data show that this has not been
achieved as of yet, despite health sector
Both public and private hospitals and reforms since 1999.
A DOH and PhilHealth review highlighted
health insurers will be required to maintain
the need to improve health-related
a health information system that will
contain electronic health records, financial risk protection among Filipinos.
prescription logs, and “human resource More importantly, PhilHealth benefit
information.” delivery was found to be the lowest among
the target population-the poorest quintile.
This system will be developed and funded
The concern on inequitable access to
by DOH and PhilHealth. It will also be
health resources has not been resolved.
subject to patient confidentiality rules and
data privacy laws. Neglect of public hospitals and health
facilities due to inadequate health
budgets has been observed. -As of
LEGAL BASIS October 2010, a total of 892 RHUs and
99 government hospitals had yet to
Universal Health Care (UHC) (Kalusugan qualify for accreditation by PhiHealth.
Pangkalahatan) also called the Aquino Data show that the poorest of the
Health Agenda is the latest in a population are the main users of
series of continuing efforts of government health facilities. -This
the government to bring about means that the deterioration and
sector reforms. Was launched poor quality of many government
through Administrative Order health facilities is particularly
2010-0036. UHC is [planned for disadvantageous to the poor who
implementation until 2016 needs the services the most.
(DOH, 2110) UHC was built -Finally, renewed efforts to achieve health
upon the strategies of two related MDGs are in order.
previous platforms of reform: The MDG 4 target is to reduce maternal
The initial Health sector reform agenda mortality rate from 209 maternal deaths
(1999-2004) /100,000 live births in 2990 to 52 deaths
FOURmula One (F1) for heath (2005- per 100,000 live births by 2015.
2010) To address these challenges, UHC
(Kalusugan Pangkalahatan) was launched
through Administrative Order 2010-0036
(DOH, 2010)
CABINGAO,B
BSN-2A
FAR EASTERN UNIVERSITY – DR. NICANOR
REYES MEDICAL FOUNDATION
COMMUNITY HEALTH NURSING LECTURE (NCM 104)
STRATEGIC INSTRUMENTS
Health financing- instrument to increase
resources for health that will be effectively
allocated and utilized to improve the
financial protection of the poor and the
vulnerable sectors.
CABINGAO,B
BSN-2A