COMMUNITY HEALTH NURSING 1
LEC
Week 1 & 2: PUBLIC HEALTH vs.
COMMUNITY HEALTH
Public Health
• Public health is the science of protecting
and improving the health of people and their
communities. This work is achieved by
promoting healthy lifestyles, researching
disease and injury prevention, and
detecting, preventing and responding to
infectious.
• A discipline that addresses health at a
population level (look at groups of people
sick & well, community or global health).
GOAL:
Contribution to the most effective total
development and life of the individual and
his society.
Core Areas of Services
Public Health Nursing
• Is the practice of promoting and protecting
the health of populations using knowledge
from nursing, social, and public health
science.
• A specialty practice within nursing and
public health.
• With a multi-level view of health, public
health nursing action occurs through
community applications of theory, evidence,
and a commitment to health equity.
• Practice includes advocacy, policy
development, and planning, which
addresses issues of social justice.
Community Health
• Considered a subdiscipline of public
health, focused on improving the health
outcomes of different groups of individuals,
often at the local level.
• Focuses on the physical and mental well-
being of the people in a specific geographic
region.
• This includes initiatives to help community
members maintain and improve their health,
prevent the spread of infectious diseases
and prepare for natural disasters.
• Working at the community level promotes
healthy living, helps prevent chronic
diseases and brings the greatest health
benefits to the greatest number of
people in need”
Community Health Nursing
• A special field of nursing that combines the
skills of nursing, public health & some
phases of social assistance and functions
as part of the total public health programme
for the promotion of health, the
improvement of the conditions in the social
and physical environment, rehabilitation of
illness and disability (WHO).
COMMUNITY HEALTH NURSE
• One of the goals:
- Is to raise awareness about certain
public health issues and help stop
the spread of preventable diseases
and illnesses.
Community Health Nursing (CHN)
• Learned practice discipline with ultimate
goal of contributing, as individuals and in
collaboration with others, to the promotion
of the client’s optimum level of the
functioning through teaching and delivery Evolution of Public Health & Public
care. Health Nursing
• Unique blend of nursing and public health
practice: Pre- Ancient Filipinos regarded
✓Human service Spanish health as a harmonious
✓Care & supervision of individuals, families, Era before relationship with the
places of work, schools and clinics. 1565 environment, both natural
and supernatural.
Concepts of CHN The The San Lazaro Church and
• Health promotion. Spanish Hospital represents early
• Benefit not only the individual but the Era (1565- medical healthcare in the
whole family. 1898) Spanish era. As the
• CH nurses are generalists in terms of their Spanish were not
practice through life’s continuum. accustomed to the climate,
• Contact with client and/or the family may food, and other challenges
continue over a long period of time which of living in the Philippines,
include all ages and all types of health care. Spanish soldiers
• Requires that current knowledge derived succumbed to a number of
from the biological and social sciences, diseases and were treated
ecology, clinical nursing & community health in hospitals specially
organizations be utilized. created for their welfare.
• The dynamic process of assessing, 1577 Public health services
planning, implementing and intervening, Intramuros opened by a Franciscan
provide periodic measurements of progress, Friar Juan Clemente.
evaluation and a continuum of the cycle 1805 Dr. Francisco de Balmis
until the termination of nursing is implicit. introduced smallpox
vaccination.
Public Health Nursing Standards: 1876 First medicos titulares
Scope & Standards of Practice (provincial health officers).
STANDARDS OF CARE 1888 UST offered a 2-year
1. Assessment course of fundamental
2. Population diagnosis and priorities medical & dental subjects.
3. Outcome Identification Cirujanos Ministrantes –
4. Planning male nurses & sanitation
5. Implementation inspectors.
6. Evaluation 1989 Creation of the Board of
STANDARDS OF PROFESSIONAL Health for Physicians
PERFORMANCE (American Regime)
7. Quality of practice 1901 United States Philippine
8. Education Commission (ACT 157)
9. Professional Practice evaluation created the Board of health
10. Collegiality & Professional relationships of the Philippine Islands.
11. Collaboration 1901 Creation of Board of Health
12. Ethics for City of Manila, Provincial
13. Research and Municipal Boards of
14. Resource Utilization Health.
15. Leadership Act # 157 (Board of Health
of the Philippines)
Act # 309 (Provincial and
Municipal Boards of Health)
 1905 BOH evolved into DOH. • Health promotion & education function
(Teacher)
La Gota de Leche, first • Training function (Nurse Educator)
center to serve mothers and • Research Function (Researcher)
babies, charity clinics.
1915 PGH began to extend PHN
services in the homes –
Social & Home Care
Service.
✓Community organizations
✓Women’s club.
1947 DOH was reorganized into
bureaus.
1954 Congress passed RA 1082
(Rural Health Act)
✓Or the creation of rural
health unit in every
municipality.
✓Physician, nurses,
midwives, sanitation
inspectors.
✓Provincial health officers
✓Dentist
1957 RA 1891 was enacted &
amended provisions in RA
1082.
1970s the Philippines health care
Delivery system was
restructured.
✓Health services are
classified: primary,
secondary, tertiary levels
1991 RA 7160 (Local
Government Code)
✓Devolution of basic health
services
✓Establishment of local
health board in very
province, city, &
municipality.

Roles & Responsibilities of a

Community Health Nurse
• Management Functions (Nurse Manager)
• Supervisory Functions (Supervisor)
• Nursing Care Function (Care Provider)
• Collaborating & Coordinating Function
(Collaborator & Coordinator)
COMMUNITY HEALTH NURSING 1
LEC
Week 3 (P1): The Health Care Delivery
System (HCDS)
Introduction
• A well-functioning health system
working in harmony is built on having
trained and motivated health workers, a
well-maintained infrastructure, and a reliable
supply of medicines and technologies,
backed by adequate funding, strong health
plans and evidence-based policies.
• Integrated health services encompasses
the management and delivery of quality and
safe health services so that people receive
a continuum of health promotion, disease
prevention, diagnosis, treatment, disease-
management, rehabilitation and palliative
care services, through the different levels
and sites of care within the health system,
and according to their needs throughout the
life course.
The Global & National Health Care
System Situation
• It focuses at its centered care for people
which includes organized health needs to
meet the expectations of the communities.
• This includes the management and
delivery of a safe health services with good
quality to provide a continuum health
promotion, disease prevention, disease
management, and palliative care services in
different levels of intervention.
The Global Health Care System
• World Health Organization is a specialized
agency of the United Nations (UN) that
manages the international public health.
• GOAL: is to ensure that a billion more
people have universal health coverage, to
protect a billion more people from health
emergencies, and provide a further billion
people with better health and well-being.
•OBJECTIVE: “The attainment by all
peoples of the highest possible level of
health"
• WHO is supporting countries in
implementing people-centered and
integrated health services by way of
developing policy options, reform strategies,
evidence-based guidelines and best
practices that can be tailored to various
country settings.
Values of World Health Organization
It reflects on:
• The principles of human rights
• Its universality
• Its established equity
• Ethical standards of the organization
• Adheres to the U N values of integrity,
professionalism and respect for diversity
WHO Individually and Collectively
Committed to put these values into
practice.
Trusted to serve public health at all
times
• We put people’s health interests first
• Our actions and recommendations are
independent
• Our decisions are fair, transparent and
timely
Professionals committed to excellence in
health
• We uphold the highest standards of
professionalism across all roles and
specializations
• We are guided by the best available
science, evidence and technical expertise
• We continuously develop ourselves and
innovate to respond to a changing world
Persons of integrity
• We practice the advice we give to the
world
• We engage with everyone honestly and in
good faith
• We hold ourselves and others accountable
for words and actions
Collaborative colleagues and partners
• We engage with colleagues and partners
to strengthen impact at country level
• We recognize and use the power of
diversity to achieve more together
• We communicate openly with everyone
and learn from one another
People caring about people
• We courageously and selflessly defend
everyone’s right to health
• We show compassion for all human beings
and promote sustainable approaches to
health
• We strive to make people feel safe,
respected, empowered, fairly treated and
duly recognized
• The WHO Representative Office for the
Philippines was established in Manila in
January 1973
1945
• diplomats met to form the United Nations
and one of the things they discussed was
setting up a global health organization.
• April 7, 1948 – WHO’s Constitution came
into force on and World Health Day.

World Health Organization Vision-

Mission
• Mission: “To promote health, keep the
world safe and serve the vulnerable with
measurable impact for people at country
level.”
• Vision: “All people attain the highest
possible level of health.”

World Health Organization Structure

• More than 7000 people from more than For Universal Health Coverage, WHO:
150 countries working in 150 country
• focus on primary health care to improve
offices, in 6 regional offices and at WHO
access to quality essential services
headquarters in Geneva, Switzerland
• work towards sustainable financing and
• Organization of 194 Member States. The
financial protection
Member States elect the Director-General,
• improve access to essential medicines and
who leads the organization in achieving its
health products
global health goals.
• train the health workforce and advise on
labour policies
“Together for a healthier world” – Dr.
• support people's participation in national
Tedros Adhanom Ghebreyesus (Director-
health policies
General)
• improve monitoring, data and information.
Dr Graham Harrison
For Health Emergencies, WHO:
– Officer-in-charge office of the WHO
• prepare for emergencies by identifying,
Representative to the Philippines
mitigating and managing risks
• prevent emergencies and support
WHO History
development of tools necessary during
outbreaks
• The Philippines, one of the WHO • detect and respond to acute health
founders, joined WHO on 9 July 1948. emergencies
• On 1 June 1951, the Philippine • support delivery of essential health
Government and the World Health services in fragile settings.
Organization signed a Host Agreement
for the establishment of the Regional
For Health and Well-being, WHO:
Office in Manila.
• address social determinants
• promote inter-sectoral approaches for
health
• prioritize health in all policies and healthy
settings.
WHO works to address:
• human capital across the life-course
• Non-communicable diseases prevention
• mental health promotion
• climate change in small island developing
states
• antimicrobial resistance (AMR)
• elimination and eradication of high- impact
communicable diseases.
The Millennium Development Goals
(MDG)
• Were eight international development
goals for the year 2015 that had been
established following the Millennium Summit
of the United Nations in 2000, following the
adoption of the United Nations Millennium
Declaration.
• The Sustainable Development Goals
succeeded the MDGs in 2016.
• The Sustainable Development Goals
(SDGs), or Global Goals, were adopted by
all United Nations Member States in 2015
as a universal call to action to end poverty,
protect the planet and ensure that all people
enjoy peace and prosperity by 2030.
The Department of Health (Kagawaran
ng Kalusugan)
• The Department of Health (DOH) is the
principal health agency in the Philippines. It
is responsible for ensuring access to basic
public health services to all Filipinos through
the provision of quality health care and
regulation of providers of health goods and
services.
• VISION: Filipinos are among the healthiest
people in Southeast Asia by 2022, and Asia
by 2040.
• MISSION: To lead the country in the
development of a productive, resilient,
equitable and people-centered health
system.
• MAJOR ROLES:
(1) leadership in health;
(2) enabler and capacity builder; and
(3) administrator of specific services.
DOH Work Values
• Integrity
• Excellence
• professionalism
• Commitment
• Compassion and respect for human dignity
• Teamwork
• Stewardship of the health of the People
 Objectives for Local Health Systems:
1. Establish local health systems for
effective & efficient delivery of health care
services.
2. Upgrade the health care management &
services capabilities of local health facilities.
3. Promote Inter-LGU linkages & cost
sharing schemes including local health care
financing systems for better utilization of
local health resources.
4. Foster participation of the private sector,
non- government organizations (NGOs) &
communities in local health systems
development.
5. Ensure the quality of health services
Local Health System Historical
delivery at the local level.
Background
• Philippine Health Care System – based in
Manila Control agency provided the singular
sources of resources, policy direction,
technical, and administrative supervision to
all health facility nationwide.
• 1991 – passage of the Local Government
Code RA 7160 all structures, personnel, &
budgetary allocations from the provincial
health level down to the barangays.

RA 7160 (Local Government Code)

• Local government executives responsible
to operate local health care services.
• Centers of authority consist of: provincial,
city, municipal governments, including an
autonomous regional government & a
metropolitan authority.
• Each center controls a portion of the
health care system as part of the political &
administrative mandate.
Provincial Operates the:
Governments Hospital system
Provincial & District
hospitals
City/Municipal Operate the:
Governments Health Centers
Rural Health Units
(RHUs)
Barangay Health
Stations (BHS)
COMMUNITY HEALTH NURSING 1
LEC
Week 3 (P2): Philippine Healthcare
Delivery System
Classification of Hospitals & other
Healthcare Facilities (DOH Administrative
Order 2012-0012)
The Philippine Health Agenda 2016-2022

New Classification of Health Facilities

Classification of Hospitals
According to Ownership
A. Government – under DOH, LGU, DND, B. Specialty Hospital
PNP, DOJ, SUCs, GOCC, etc. C. Trauma Capability Hospitals
B. Private – individual, corporation,
association or organization New Classification of other Health
Facilities
According to Scope of Services
1. General – Clinical Services (Family
Medicine, Pediatrics, Internal Medicine, Ob-
Gyne, Surgery); Emergency Services;
Outpatient Services; Ancillary & Support
Services
2. Specialty – Treatment of patients
suffering from disease of particular organ,
particular condition and/or particular group.

According to Functional Capacity

A. New Classification of General
Hospitals

All For Health towards Health For All
Philippine Health Agenda
2016-2022
The Health System We Aspire For
GOALS
• Financial Protection
• Better Health Outcomes
• Responsiveness
VALUES
• Equitable & Inclusive to all
• Uses Resources Efficiently
• Transparent & Accountable
• Provide High Quality Services
Persistent Inequities in Health
Outcomes
• Every year, around 2000 mothers die
due to pregnancy-related complications.
• A Filipino child born to the poorest
family is 3 times more likely to not reach
hist 5th birthday, compared to one born to
the richest family.
• Three out of 10 children are stunted.
Restrictive & Impoverishing Healthcare
Costs
• Every year, 1.5 million families are
pushed to poverty due to health care
expenditures.
• Filipinos forego or delay care due to
prohibitive and unpredictable user fees or
co-payments.
• ₱4,000 per month healthcare expenses
considered catastrophic for single income
families.
Poor Quality & Undignified Care
Synonymous with Public Clinics &
Hospitals
• Long wait times
• Limited Autonomy to choose provider
• Less than hygienic restrooms, lacking
amenities
• Privacy and confidentiality taken lightly
• Poor record-keeping
• Overcrowding & under-provision care
3 Guarantees
1. All Life Stages & Triple Burden of
Disease
- Services for both the well & the sick
2. Service Delivery Network
- Functional Network of Health Facilities
3. Universal Health Insurance
- Financial Freedom when Accessing
Services
All Life Stages & Triple Burden of
Disease
All Life Stages
• Pregnant
• Newborn
• Infant
• Child
• Adolescent
• Adult
• Elderly
Triple Burden of Disease
• Communicable Disease
- HIV/AIDS, TB, Malaria; Disease for
Elimination; Dengue, Leptospirosis,
Ebola, Zika
• Non-Communicable Disease
- Cancer, Diabetes, Heart Disease
and their Risk Factors – obesity,
smoking, diet, sedentary lifestyle;
Malnutrition
• Diseases of Rapid Urbanization
- Injuries; Substance abuse; Mental
Illness; Pandemics, Travel Medicine;
Health consequences of climate
change/disaster.
Service Delivery Network
• FULLY FUNCTIONAL (Complete
Equipment, Medicines, Health Professional)
• COMPLIANT WITH CLINICAL PRACTICE
GUIDELINES
• AVAILABLE 24/7 & EVEN DURING
DISASTERS
• PRACTICING GATEKEEPING
• LOCATED CLOSE TO THE PEOPLE
(Mobile Clinic or Subsidize Transportation
Cost)
• ENHANCED BY TELEMEDICINE
Universal Health Insurance
Services are Financed Predominantly by
Philhealth
• Philhealth as the gateway to Free
Affordable Care
• Simplify Philhealth Rules
• Philhealth as Main Revenue Source for
Public Health Care Providers
Strategy
A – Advance quality, health promotion and
primary care
C – Cover all Filipinos against health-related
financial risk
H – Harness the power of strategic HRH
development
I – Invest in eHealth and data for decision-
making
E – Enforce standards, accountability and
transparency
V – Value all clients and patients, especially
the poor, marginalized, and vulnerable
E – Elicit multi-sectoral and multi-
stakeholder support for health
COMMUNITY HEALTH NURSING 1
LEC
Week 4: Primary Healthcare
Definitions
• Is an over-all approach to providing people
access to basic healthcare and ultimately
improve health of communities.
•"PHC is a whole-of-society approach to
health that aims at ensuring the highest
possible level of health and well-being and
their equitable distribution by focusing on
people’s needs and as early as possible
along the continuum from health promotion
and disease prevention to treatment,
rehabilitation and palliative care, and as
close as feasible to people’s everyday
environment. “WHO & UNICEF
History of PHC
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.
Sept, 6-12, 1978
• Alma Ata, USSR 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).
Oct. 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.
Global Conference on Primary Health
Care: 25-26 October 2018 – Astana,
Kazakhstan
The 2018 Declaration of Astana
centers around 4 commitments:
HISTORY
• Making bold political choices for health
across all sectors;
• Building sustainable primary health care –
adapted to each country’s local context;
• Empowering individuals and communities
• Aligning stakeholder support to national
policies.
Goal of PHC
• Primary health care seeks to ensure that
all people regardless of age, sex, creed,
religion, ideology, and race are provided
access to basic health services.
Towards UHC and the SDGs
PHC Committed to:
“Everyone has the right to a standard of
living adequate for the health and wellbeing
of himself and of his family, including food,
clothing, housing and medical care and
necessary social services”
• Social justice and equity and in the
recognition of the fundamental right to the
highest attainable standard of health.
Irrelated Elements of PHC
• Comprehensive integrated health services
that embrace primary care as well as public
health goods and functions as central
pieces.
• Multi-sectoral policies and actions to
address the upstream and wider
determinants of health.
• Engaging and empowering individuals,
families, and communities for increased
social participation and enhanced self-care
and self-reliance in health.
Facts (WHO)
•About 930 million people worldwide are at
risk of falling into poverty due to out-of-
pocket health spending of 10% or more of
their household budget.
• Scaling up primary health care (PHC)
interventions across low and middle
income countries could save 60 million lives
and increase average life expectancy by 3.7
years by 2030.
• Achieving the targets for PHC requires an
additional investment of around US$ 200 to
US$ 370 billion a year for a more
comprehensive package of health services.
• At the UN high level UHC meeting in 2019,
countries committed to strengthening
primary health care. WHO recommends that
every country allocate or reallocate an
additional 1% of GDP to PHC from
government and external funding sources.
Importance of PHC
• PHC provides the 'programmatic engine'
for UHC, the health-related SDGs and
health security.
“The health-related SDGs and health
security goals are ambitious but
achievable.”
• This commitment has been codified and
reiterated in the Declaration of Astana, the
accompanying World Health Assembly
Resolution 72/2, the 2019 Global Monitoring
Report on UHC, and the United Nations
General Assembly high-level meeting on
UHC.
The Concept of Primary Health Care
• Partnership and Empowerment of the
people that shall permeate as the core
strategy in the effective provision of
essential health services that are
community based, accessible, acceptable
and are sustainable at a cost which the
community and the government can afford.
WHO has identified Three Strategic
Areas of work to strengthen PHC
worldwide:
• Providing a 'one-stop' mechanism for PHC
implementation support to Member States,
tailored to country context and priorities.
• Producing PHC-oriented evidence and
innovation, with a sharper focus on people
left behind.
• Promoting PHC renewal through policy
leadership, advocacy and strategic
partnerships with governments,
nongovernmental organizations, civil society
organizations, development partners, UN
sister agencies, donors, and other
stakeholders at global, regional and country
levels.
Core Strategies Levers
• Political commitment and leadership
• Governance and policy frameworks
• Funding and allocation of resources
• Engagement of community and other
stakeholders
Operational Levers
• Models of Care
• Primary health care workforce
• Physical infrastructure
• Medicines and other health products
• Engagement with private sector providers
• Purchasing and payment systems
• Digital technologies for health
• Systems for improving the quality of care
• Primary health care- oriented research
• Monitoring and evaluation
2. L – Locally endemic disease prevention
and control.
3. E – An expanded program of
immunization against major infectious
diseases.
4. M – Maternal and child health care
including family planning.
5. E – Essential drugs arrangement,
6. N – Nutritional food supplement, an
adequate supply of safe and basic nutrition.
7. T – Treatment of communicable and non-
communicable diseases and the promotion
of mental health.
8. S – Safe water and sanitation.

PHC: People-Centered Care

•Ensuring health services are tailored to
people’s needs
• Are provided in partnership with them
rather than simply given to them
• Care received: At the Right time and In
the Right place
• Care where individual, families and
communities are respected, informed,
engaged, supported and treated with dignity
and compassion.

Essential Health Services in PHC

1. E – Education: concerning prevailing

health problems and the methods of
identifying, preventing, and controlling them.