BACHELOR OF SCIENCE IN NURSING

COMMUNITY HEALTH NURSING 2

COURSE COURSE WEEK

MODULE UNIT
1 2 2

Concepts of the Community

and
Philippine Health Situation

Read course and unit objectives

Read study guide prior to class attendance Read required
learning resources; refer to unit terminologies for jargons
Proactively participate in classroom discussions Participate in
weekly discussion board (Canvas) Answer and submit course
unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Describe the different types of community in Philippine setting
2. Cite the distinguishing features of Community Health Nursing.
3. Compare characteristics of your community from others.
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
3. Accept comments and reactions of classmates on one’s opinions openly andgraciously.
4. Develop heightened interest in studying Community Health Nursing.
Psychomotor:
1. Participate actively during class discussions and activities
2. Express opinion and thoughts during class

Famorca, Z. 2013. Nursing Care of the Community, a comprehensive text on community and
public health nursing in the Philippines, 2013, 4 – 7.

This unit is consist of two parts. First is the topic ‘Concept of the Community’ followed by
‘Philippine Health Situation.”

UNIT 2.a. ‘ CONCEPT OF THE COMMUNITY ’

Community is a group of people with common characteristics or interests living together within
territory or geographical boundary
It is a place where people under usual conditions are found.

Types of Community

Geopolitical Phenomenological
community community

territorial functional

ex. school ex.

barangay
Characteristic of Healthy Community
Adapted from Hunt, 1997 and Duhl, 2002

Shared sense of being a community based on

history and values
General feeling of empowerment and control
over matters affecting the community as a
whole
Existing structures that allow subgroups in
the community

Ability to cope with change, solve problems &

manage conflicts within the community

Open channel of communication

Equitable and efficient use of community

resources

Factors Affecting Health of the Community

Community has 3 features. It includes population, location and social systems.
A. Characteristics of the People / Population
: Population size and density influences the number and size of health care institutions

: Health needs of community varies because of differences in population composition by

age, sex, occupation, level of education and other variables

: Other factors are rapid growth or decline of a population, the feeling of belonging and
participation in community action including level of education and social class.

B. Location of the Community

: Health of community is affected by both natural and man-made variables related to
location.

: Geographic features consist of land and water forms that influence food sources and
prevalent occupations. : Geography plays an important role in disasters

: Effects of climate change on human health are evidenced by seasonal diseases.

 : Geographic location of the Philippines makes it vulnerable to natural hazards. The country
in the so called “Ring of Fire,” in which volcanic eruptions and earthquakes are frequent

: Other factors that affects health of community are plants and fauna. It also includes community
boundaries, air water and soil pollution.

: Factors that contribute to health problem in urban are: higher population density while
factors that contribute to health problem in rural are: inequalities of resources and
economic opportunities, .

C. Social Systems within the community

: Social system is the patterned series of interrelationships existing between individuals,
groups and institutions and forming a coherent whole.

: This includes the following: family economic, educational, communication, political, legal,
religious, recreational and health system.

To Read: Read and comprehend how health is affected by people, location & social services in:
Famorca, Z. 2013. Nursing Care of the Community, a comprehensive text on community and public health
nursing in the Philippines, 2013, 4 – 7.

Roles and Activities of Community Health Nurse

: Roles and activities of community health nurse and its sub-specialty are connected
with following:

CLINICIAN / CARE
EDUCATOR
PROVIDER

ADVOCATE MANAGER

RESEARCHER COLLABORATOR

LEADER

To watch: View and relate the roles and responsibilities of Community Health Nurse in the video.
https://www.youtube.com/watch?v=1rjtdz3Qxyk
The intervention Wheel.
The Minnesota Intervention Wheel is a tool that illustrates what public health nurses
do to improve health outcomes. Descriptions are as follow:

Surveillance: Describes and monitor health events

Disease & other health investigation: Systematically gathers & analyzes data regarding threats,
ascertain source, what to do & how services can be obtained.

Outreach: Locates populations & provides information about the nature of concern,
what can be done & how services can be obtained

Screening: Identifies unrecognized health risk factors or asymptomatic disease conditions

Case finding; Locates those with identified risk factors & connects them with resources

Referral and follow – up: Assist to identify & access necessary resources to prevent or resolve
problems
Case Management: Optimizes self-care capabilities of individuals & families &
capacity of community

Delegated functions:Direct health task that are carried out

Health teaching:Communicates facts, ideas and skills that change knowledge ,

attitudes, values, beliefs, behaviors & practices

Counselling:Establishes an interpersonal relationship with an intention of increasing /

enhancing capacity for self – care.

Consultation:Seeks information & generates optional solution

Collaboration: Commits two or more persons to achieve a common goal

Coalition building:Promotes & develops alliances among organizations or constituencies for

common purpose

Community organizing: Helps community groups identify common problems, mobilize

resources & develop/ implement strategies to realize goal collectively

Image of intervention depicted below shows the individual – focused, community – focused,
system – focused & population – based approaches when intervening concerns related to
public health.
 To watch: View and understand The Intervention Wheel in the link provided below:
https://www.youtube.com/watch?v=5rKbqpWwFM8 at 6:41

Unit 2. b. ‘PHILIPPINE HEALTH SITUATION’

Information on the health status of the nation as a whole gives us an idea of the health
status in the communities where we are assigned as community / public health nurses. Here are
the health profiles and demographics of the Philippines.

DEMOGRAPHICS
The population provides an understanding of the health status of populations.

In terms of demographics, this module walks around only those key issues connected to the
assessment of the health status that interface with the analysis of health.

Total Population (2020)109, 947,900

Total population (2016) 103,320,000
 Projected population of the Philippines is 104.9 million
as of 2017, based on the 2015 Census of Population
conducted by the Philippine Statistics Authority. The
Philippines is the thirteenth most populous country in
the world.

As of 2017, urban migration in the Philippines,

particularly towards the National Capital Region (NCR),
which hosts 12.7% of the population. This creates
problems in the area of housing, road traffic, pollution
and crime.

The Philippines has a young population with about a third of its population younger than 15 years
of age as of 2017. Median age is 24.3

The ageing index (Gavrilov LA et al., 2003) or the proportion of persons aged 65 years and over
per 100 persons. Most countries are considered aging if they have at least 7% of the population
over 65 years old," according to POPCOM.

The population growth rate has declined by almost half, from 2.7 to 1.5 during the same period.

The overall age dependency ratio declined by about a third (28.8) between 1980 (86.3) and 2017
(57.5) which is consistent with the decreasing trend of the child dependency ratio. However, the
trend in the elderly dependency ratio is slowly increasing, reflecting the growing elderly population.
Consistent with the increasing population, the population density doubled from 159 persons per sq.
km in 1980 to 352 persons per sq. km in 2017. In the same period, the proportion of the population
residing in rural areas decreased from 62.5% to 55.8%.

Of the estimated 71.6 million population aged 15 years and over, 44.6 million persons were in the
labour force in 2017. Among them, 39.9% were women (World Bank, 2018b).

Number of households 22,975,630 ; Average household size 4.4 ; Literacy rate 98.3

Major cities by population are 13.699 million MANILA (capital), 1.785 million Davao, 967,000
Cebu City, 905,000 Zamboanga, 859,000 Antipolo (2019)

HEALTH PROFILE

BIRTHS

Births in the Philippines, 2017

(Based on PSO)

Sixteen births per thousand population

Year 2017, registered live births were 1,700,618. This is equivalent to a crude birth rate (CBR) of
16.2 or 16 births per thousand population.

The number of registered live births

showed a decreasing trend, noticeably
from 2012 to 2017. The decrease
in the last five years was 5.0
percent,
from 1,790,367 live births in 2012 to
1,700,618 recorded births in 2007

Several factors may contribute to the declining births, such as social change or lifestyle choices
associated by economic affluence.

In the National Demographic and Health Survey (NDHS,2017), the total fertility rate declined
steadily over time to 2.7 children per woman in 2017.

More males born than females

More males (887,972 or 52.2%) were born

than females (812,646 or 47.8%) which
resulted in a sex ratio of 109 males per
100 females.

On the average, there were about 4,659

babies born daily or about 194 babies
born per hour or approximately three
babies born per minute.

Highest occurrence of births in NCR.

Of the total live births, 57.8 percent were born in Luzon, 19.1 percent in Visayas and 23.1 percent
in Mindanao.

In the total number of births in the

Philippines, 93.3 % birth
deliveries were attended by health
professionals such as physician,
midwife or nurse.

ARMM showed very low

proportion of medically attended
births. More than half of births that
occurred in the region were
attended by Traditional Birth
Attendant (hilot /unlicensed
midwife).2017
FAMILY PLANNING 7/ (Source: PSA)
Any modern method 40.4
Any traditional method 13.9
Not currently using 45.7
Median age at first birth among women 25-29 (Mother's mean age at first birth 22.8 years, 2017
est.)

More than half of babies born to unwed mothers

More than half ( 53.3%) of the
total registered live births in
2017 were born out of
wedlock .

The recorded highest number

of illegitimate children born in
2017 by usual residence of
mother were CALABARZON
followed by NCR

More babies born to adolescent mothers

Babies born to adolescent mothers
(196,478) were more than those babies sired by
adolescent fathers (52,342).

Babies sired by fathers aged

50 years old and over (27,068) were far more than
babies born to mothers of the same age group (328).

Modal age group of childbearing in 2017 was at 20-24 years old. Highest frequency of live
births belonged to mothers in this age group. On the other hand, fathers aged 25-29 were
recorded to have e highest frequency of live births.

The median age of mothers giving birth was 26 and for fathers was 29 years old.

MORTALITY
Mortality rates declined from 2015 to 2016.

2016 2015 2014

Deaths
(Accdg to civil
registration) 579,262 582,183 560,605
Male 332,529 334,678 321,624
Female 246,733 247,505 238,981
In 2017, an average of 1,587 persons died daily or to 66 deaths per hour or one per minute.

In 2017, the number of deaths in

males (332,517) was higher than
deaths in females (246,720).

The Age And Sex Pattern Of Death in

2017, reflects an inverted pyramid,
with fewer deaths at younger ages,
except for children under one,
& progressively

Higher proportions of female deaths observed in older

age groups.

Out of 579,237 registered deaths, about half or 292,098 were not attended by
medical doctor or any other allied health care provider

Top three regions in terms of number of deaths by usual residence were found in Luzon:
CALABARZON followed by NCR then Central Luzon. On the other hand, the three regions which
had the least number of deaths were ARMM, CAR and Caraga.

Top 3 Leading Causes of Death (2016)

1. Ischemic heart diseases

74,134
2. Malignant neoplasms (cancer)
60,470

3. Pneumonia
57,809
The month of August recorded the highest number of deaths followed by January. February had
the least number percent share of the total deaths.

MORBIDITY, ENDEMIC AND OUTBREAKS

Leading cause of morbidity in 2005 is Acute Lower Respiratory Tract Infection and Pneumonia.
This is followed by bronchitis / bronchiolitis

There were infectious diseases that have emerged each as the severe acute respiratory syndrome
(SARS).
Obesity - adult prevalence rate 6.4% (2016). Maternal mortality rate 121 deaths/100,000 live
births (2017 est.). Children under the age of 5 years underweight 21.5% (2015)

Major infectious disease with degree of risk are (2016) : food or waterborne diseases: bacterial
diarrhea, hepatitis A, and typhoid fever (2016) ; vectorborne diseases: dengue fever and malaria
(2016) ; water contact diseases: leptospirosis (2016).

HIV/AIDS - adult prevalence rate 0.1% (2018 est.); HIV/AIDS - people living with HIV/AIDS 77,000
(2018 est.) ; HIV/AIDS – deaths 1,200 (2018 est.).

There is a steady increase, though relatively slow, in the number of HIV seropositive cases in the country.
From 1982 to 2006, cases is not just associated with homosexuality. One – third were OFW. 74% were males.
Around 93% through sexual intercourse. There is also an increase of syphilis and gonorrhea (DOH, 2006).

Rate of Malaria, TB and HIV from 2009 to 2019 in the Philippines released by WHO.

Schistosomiasis continues to affect hundreds of barangays in 24 endemic provinces.

 Mapping of Filariasis in the Philippines.

Polio outbreak in the Philippines ( Reported by WHO, 2019)

In September 2019, Philippines declared an outbreak of polio. Two cases were reported. First
case was confirmed on 14 September. Case-patient is a 3-year-old girl from Lanao del Sur in the
southern Philippines. The second case was confirmed on 19 September and is a 5-year-old boy
from Laguna Province. Virus isolated are both genetically linked to VDPV2 previously isolated from
environmental samples in Manila and Davao caused by vaccine-derived poliovirus type 2 (VDPV2).
Environmental samples taken from sewage in Manila on 13 August and a waterway in Davao on
22 August have tested positive for VDPV2.

Measles Outbreak in the Philippines.( Reported by UNICEF-WHO)

Measles outbreak started late 2017 in Mindanao. In 2018,

20,827 cases were reported with 199 deaths. With a Case
Fatality Rate (CFR) of 1,37% Outbreak &
supplementary immunization activities in 2018
were ineffective due to vaccine hesitancy . Weak routine
immunization led to decrease in overall immunization
coverage, a large immunity gaps among younger children
against vaccine preventable diseases including measles

Reported through Philippines Integrated Disease Surveillance & Response (PIDSR) system.
From January to June 2019, current
dengue incidence is 85% higher than
in 2018, in spite of a delayed rainy
season.

DOH declared a National Dengue

Alert in July 2019.
 Regional DOH step up dengue surveillance, case management & outbreak response in
primary health facilities situations, vector control, and logistics support for dengue control
(insecticides, RDTs, medicine, etc).

DOH Statement on Diphtheria (September 2019).

Cases of diphtheria and other infectious diseases are monitored by the Epidemiology Bureau
regularly. From January 2019 – September 2019, there have been 167 cases and 40 deaths
compared to 122 cases and 30 deaths cases in the same period in 2018. The reasons for the trend
are being investigated. The Department of Health (DOH) urges parents to ensure that their children
receive the complete dose of all recommended vaccines in their first year of life.
Statement from WHO, May 2020

A new virus and disease were unknown before

the outbreak began in Wuhan, China, in
December 2019. On 30 January 2020.

Philippine Department of Health reported the

first case of COVID-19 in the country with a 38-
year-old female Chinese national.

On 7 March, the first local transmission

of COVID-19 was confirmed.

Aggregate - is literally defined as the sum or the whole. Community - is a part of that whole.

Department of Health - The Department of Health (DOH) is the country's principal health agency.
It is responsible for ensuring access to basic public health services through the provision of quality
healthcare and the regulation of providers of health goods and services.

Geopolitical Community – is a community with defined geographical and jurisdictional

boundaries, such as rural municipalities, towns or city communities. A is the procedure of
systematically acquiring and recording information about the members of a given population.

Phenomenological Community - A group of people who are defined by sharing values, customs,
interests, religion or academic interests. It is a phenomenological community because members
share common beliefs and interests allocates them to the place where enumerated—normally
where they spend the night of the day enumerated.

Philippine Statistics Authority - abbreviated as PSA, is the central statistical authority of the
Philippine government that collects, compiles, analyzes and publishes statistical information on
economic, social, demographic, political affairs and general affairs of the people of the Philippines
and enforces the civil registration functions in the country.

World Health Organization - The World Health Organization is a specialized agency of the United
Nations responsible for international public health. The WHO Constitution, which establishes the
agency's governing structure and principles, states its main objective as "the attainment by all
peoples of the highest possible level of health."

Famorca, Z. 2013. Nursing Care of the Community, a comprehensive text on community and
public health nursing in the Philippines, 2013, 4 – 7.

Fooladi, M. M. (2015). The Role of Nurses in Community Awareness and Preventive Health.
International Journal of Community –Based Nursing and Midwifery,3 (4): 328-329.

https://www.sciencedirect.com/science/article/pii/S0020748919302810 Delivery of Public Health

Network in Remote Communities

National QuickStart as of December 2019

https://psa.gov.ph/statistics/quickstat/national-quickstat/all/*

PHILPPINE Health Situation At a Glance

https://www.philrights.org/wp-content/uploads/2010/10/The-Philippine-health-situation-at-a-
glance.pdf

The Philippines Health System Review, 2018

https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-
eng.pdf?sequence=1&isAllowed=y

Useful link Practice Test. Applicable for Local Board Exam and NCLEX Community Health
Nursing at https://www.youtube.com/watch?v=_Eiei0hEB1s
Suggested task:

1. Choose a popular community. Attached picture if possible

( can be downloaded from internet)

2. Compare and contrast your own community from it in terms

of people, location and social system.

3. What features from each communities can lead to wellness and / or illness? Which community
can have higher rate of wellness & / or wellness? Which is a more appropriate residence for
vulnerable groups, working class and others.

Submit as a file document attachment

Famorca, Z. 2013. Nursing Care of the Community, a comprehensive

text on community and public health nursing in the Philippines.

Maglaya, A. 2009. Nursing Practice in the Community, Argonauta Corporation

https://www.who.int/countries/phl/en/
Prepared by Aida V. Garcia, MAN. RN