I.

OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Objectives:
o Integrate relevant principles of social, physical, natural, and health sciences and humanities in a
given health and nursing situation.
o Discuss appropriate community health nursing concepts and actions holistically and
comprehensively.

A. Global and National Health Situations

∙ Global Health Situation (World Health Organization, 2018a)

Collecting and comparing health data from across the globe is a way to describe health
problems, identify trends and help decision-makers set priorities.

Studies describe the state of global health by measuring the burden of disease – the loss of
health from all causes of illness and deaths worldwide. They detail the leading causes of deaths
worldwide and in every region, and provide information on more than 130 diseases and injuries
across the world.

1. Global average life expectancy increased by 5 years between 2000 and 2015, the
fastest increase since the 1960s – Life expectancy at birth reflects the overall mortality
level of a population. It summarizes the mortality pattern that prevails across all age
groups in a given year – children and adolescents, adults and the elderly. Global life
expectancy at birth in 2015 was 71.4 years (73.8 years for females and 69.1 years for
males).
2. Globally, healthy life expectancy (HLE) at birth in 2015 was estimated at 63.1 years – The
gap between life expectancy and HLE at birth – 8.3 years in 2015 – represents the
equivalent healthy years lost through morbidity and disability that a newborn could
expect to experience. There are substantial differences between male and female HLE in
all WHO regions, with female HLE being higher.
3. In 2015, more than 16 000 children under age five died every day – Almost all of these
children’s lives could be saved if they had access to simple and affordable interventions
such as exclusive breastfeeding, inexpensive vaccines and medication, clean water and
sanitation. Children are at a greater risk of dying before age five if they are born in poor
households, rural areas, or to mothers denied basic education.
4. 45% of deaths among children under age five occur during the first four weeks of life –
Prematurity, birth-related complications and neonatal sepsis were the leading causes of
deaths among newborn babies in 2015. The Sustainable Development Goals specifically
targets ending preventable newborn deaths by 2030, with all countries aiming to reduce
neonatal mortality to at least as low as 12 per 1000 live births.
5. In 2015, an estimated 2.6 million babies were stillborn
6. 1.3 million deaths in 2015 were attributable to hepatitis – Hepatitis is an inflammation
of the liver, that can progress to fibrosis (scarring), cirrhosis or liver cancer. Most
hepatitis deaths are due to hepatitis B and C. Globally, in 2015, an estimated 257 million
people were living with chronic HBV infection, and 71 million people with chronic HCV
infection. Few people with viral hepatitis have been diagnosed, and among those,
treatment has reached only a small fraction.
7. Noncommunicable diseases (NCDs) caused 37% of deaths in low-income countries in
2015, up from 23% in 2000 – In low-resource settings, health-care costs for
cardiovascular diseases, cancers, diabetes or chronic lung diseases – the four main
causes of NCD deaths – can quickly drain household resources, driving families into
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 poverty. Globally, 70% (nearly 40 million) deaths in 2015 were due to NCDs. NCDs are
often associated with older age groups, but 43% of all NCD deaths in 2015 occurred
before the age of 70.
8. Ischaemic heart disease and stroke killed 15 million people in 2015 – These and other
types of cardiovascular diseases caused 31% of all deaths globally. Cessation of tobacco
use, reduction of salt in the diet, consuming fruits and vegetables, regular physical
activity and avoiding harmful use of alcohol have been shown to reduce the risk of
cardiovascular disease, as well as other NCDs.
9. Diabetes are among the 10 leading causes of deaths and disability worldwide –
Disability-adjusted life-years (DALYs) per 100 000 population due to diabetes increased
by over 31% between 2000 and 2015, putting it in the top 10 causes of DALYs. Number
of deaths, and death rate per 100 000 population, increased by 66% and 38%,
respectively, during the same period.
10. Injuries claimed nearly 5 million lives in 2015 – Over a quarter (27%) of these deaths
were due to road traffic injuries. Low-income countries as a group had the highest
mortality rate due to road traffic injuries with 28.5 deaths per 100 000 population – the
global rate was 18.3. By contrast, high-income countries experienced the highest suicide
rate at 14.5 deaths per 100 000 population – the global rate was 10.7.

∙ National Health Situation

Over the years, Filipinos have lived better, longer and healthier through the health
investments and advances produced by the Philippines. Despite these significant
changes, most vulnerable groups have not yet received the benefits of this growth, and
the health system remains fragmented.

These are the positive changes in the country (World Health Organization, 2018b):
✔ Health insurance covers 92% of the population.
✔ Maternal and child health services have improved. More children have lived
beyond infancy. Women delivering at health facilities have increased. More
births have been attended by professional service providers than ever before.
✔ Access to and provision of preventive, diagnostic and treatment services for
communicable diseases have been better. There are also several initiatives to
reduce illness and death due to noncommunicable diseases (NCDs).

However, health achievements have not been equal. There is still a barrier between
regions, the rich and the poor, and the different population groups. A lot of Filipinos
continue to die or suffer from diseases that have well-proven and cost-effective
interventions, such as tuberculosis, HIV and dengue, or diseases affecting mothers and
children. With this lack of sufficient knowledge to a better health, many people
experience health problems. Some factors that increase the risks associated with health
and environmental challenges are the rapid economic development, urbanization, rising
climate change, and widening exposure to diseases and pathogens in an increasingly
global world.

B. Definition and Focus

1. Health – It is defined by the World Health Organization as a “state of complete physical, mental,
and social well-being, not merely the absence of disease or infirmity”.

2. Public Health – the science of protecting the safety and improving the health of communities
 through education, policy making and research for disease and injury prevention (University of
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Pittsburgh Graduate School of Public Health, 2019). It is the science and art of preventing
disease, prolonging life, promoting health and efficiency through organized community effort.

3. Community Health – is a medical specialty that focuses on the physical and mental well-being of
the people in a specific geographic region (Brooks, 2019).

4. Public Health Nursing – the practice of promoting and protecting the health of populations using
knowledge from nursing, social, and public health sciences. Nurses influence the wellbeing of
patients. Nurses should encourage healthy lifestyle changes and provide education on healthy
living, specifically the most vulnerable in the society (American Public Health Association, 2013).
It is a special field of nursing that combines the skills of nursing, public health and some phases
of social assistance and functions as part of the total public health programme.

5. Public Health Nurses – These are nurses in the Philippines who have made great contributions to
the improvement of the health of the people for more than a century now. They have been
leaders in providing quality health services to communities.

6. Community Health Nursing (CHN) – the practice of community health nurses or public health
nurses to identify people in need and reach out to them. Health nurses help the community by
exerting efforts to aid vulnerable groups of people (Arkansas State University Academic
Partnerships, 2017). It is a service rendered by a professional nurse with communities, groups,
families, individuals at home, in health centers, in clinics, in schools and in places of work.

7. Standards of Public Health Nursing in the Philippines

The standards of Public Health Nursing in the Philippines developed by the National League
of Philippine government Nurses in 2005 described the qualification and functions of a Public
Health Nurse.

The public health nurse

∙ Must be professionally qualified and licensed to practice in the area of public health
nursing.
∙ Must possess personal qualities and “people skills” that would allow her practice to
make a difference in the lives of these people.
∙ Functions in accordance with the dominant values of public health nurses, within the
ethico-legal framework of the nursing profession, and in accordance with the needs of
the clients and available resources for health care.
∙ Functions of PHN are consistent with the Nursing Law 2002 and program policies
formulated by the DOH and local government health agencies. They are related to
management, supervision, provision of nursing care, collaboration and coordination,
health promotion and education training and research.

Management Function
∙ The management function of the public health nurse is inherent in her practice. ∙ The
nurse, in whatever setting and role has been trained to lead and manage. ∙ Objectives set
for work being done can only be achieved through the execution of the
five management functions of planning, organizing, staffing, directing and controlling.
∙ This function is performed when she organizes the “nursing service” of the local health
agency.
 ∙ Managing the nurses and their activities.
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Program management
∙ This is a function where the PHN actually excels in.
∙ A program manager is responsible for the delivery of the package of services provided
by the program to the target clientele.
∙ Reports on program accomplishments is a documentation of her management skills.

Supervisory Function
∙ PHN is the supervisor of the midwives and other auxillary health workers in the
catchment area.
∙ Formulates a supervisory plan and conducts supervisory visits to implement plan. ∙
Conducts supervisory visits using a supervisory checklist
∙ During the visit the PHN identifies together with the supervisee any issue or problem
encountered and addresses them accordingly.
∙ Coaching
∙ Enhancement of training for the supervisee
∙ Report of the encounter is given to the supervisee and kept in her personal file for
future reference.

Nursing Function
∙ An inherent function of the nurse - Her practice as a nurse is based on the science and
art of caring
∙ Public health nursing is caring for individuals, families and communities toward health
promotion and disease prevention
∙ PHN are expected to provide nursing care
∙ PHN uses her knowledge and skill in the nursing process. She does assessment, plans,
and implements care, and evaluates outcomes.
∙ Establishes rapport with her client: individual, family or community
∙ Home visits
∙ Referral of patients to appropriate levels of care

Collaborating and coordinating Function

∙ Brings activities or group activities systematically into proper relation or harmony with
each other.
∙ Care coordinators for communities and their members
∙ Actively involved both socially and politically to empower individuals, families and
communities as an entity to initiate and maintain health promoting environments. ∙
Establishes linkages and collaborative relationships with other health professionals,
government agencies, the private sector, NGOs, people’s organizations to address health
problems.
∙ Identifies persons, groups, organizations, other agencies and communities whose
resources are available within and outside the community and which can be tapped in
the implementation of individuals, family and community health care.

Health Promotion and Education Function

∙ Activities goes beyond health teachings and health information campaigns. ∙
Understands that health is determined by various factors such as physical and political
environment, socio-economic status, personal coping skills and many other
circumstances, and it is inappropriate to blame or credit a person’s health to himself
alone because he is unlikely to control many of these factors.
 ∙ Understanding the multidimensional nature of health will enable her to plan and
implement health promoting interventions for individuals and communities.
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∙ Uses her skills in advocacy for the creating of a supportive environment through policies
and reengineering of the physical environment for healthier actions.
∙ As an educator, the nurse provides clients with information that allows them to make
healthier choices and practices.
∙ Health education is a major component of any public health program.
∙ PHN are expected to teach on a daily basis as part of their practices.

Training Function
∙ Initiates the formulation of staff development and training programs for midwives and
other auxillary workers
∙ Does training needs assessment for these health workers, designs the training program
and conducts them in collaboration with other resource persons.
∙ Also does evaluation of training.
∙ PHN participates in the training of nursing and midwifery affiliates in coordination with
the faculty of colleges of nursing and midwifery.
∙ Participates in teaching, guidance and supervision of student affiliates for their RLEs in
the community setting.
∙ Health promotion calls for the active participation of the community.
∙ Mobilize communities for health actions.
∙ Community organizing is a means of mobilizing people to solve their own problems.
Through this, people learn that their problems have social causes and fighting back is a
more reasonable, dignified approach than passive acceptance and personal alienation.

Research Function
∙ Participates in the conduct of research and utilizes research findings. - PHN function is
disease surveillance. Purposes of disease surveillance: To measure the magnitude of
the problem , to measure the effect of the control program - It is important in
monitoring the progress of the disease reduction initiatives: Poliomyelitis, Neonatal
Tetanus Elimination, Measles Control, NCD risk factors, etc.

8. Evolution of Public Health Nursing in the Philippines

HISTORY OF PUBLIC HEALTH & PUBLIC HEALTH NURSING (Santos, E. & Santos, H. P., 2004)

1) Spanish Regime (1565-1898)

∙ Bro. Juan Climente (1577) – Started Public Health Services though a dispensary in
Intramuros
∙ Started water sanitation
∙ Introduced small pox vaccine
∙ Creation of position of district, provincial, national health officers
2) American Regime (1898- 1942)
∙ 1898
- creation of board of the Health for Physician
- Department of Health was first established as Department of Public Works,
Education and Hygiene.
∙ 1899 – appointment of the first commissioner of health
∙ 1906 – abolition of the board of health, creation of bureau of health
∙ 1912
 - PHN started in Cebu with 4 graduate nurses who dealt primarily in MCH
services
- The Fajardo Act (Act No. 2156) created Sanitary Divisions.
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- The President of Sanitary Division took charge of two or three municipalities.

Where there are no physicians available, male nurses were assigned to
perform the duties of the President, Sanitary Division.
- Philippine General Hospital (PGH), then under the Bureau of Health sent four
nurses to Cebu to take of mothers and their babies.
- St. Paul’s Hospital School of Nursing in Intramuros, also assigned two nurses
to do home visiting in Manila and gave nursing care to mothers and newborn
babies from the outpatient obstetrical service of the PGH.
∙ 1914
- School nursing was rendered by a nurse employed by the Bureau of Health in
Tacloban, Leyte.
- Reorganization Act No. 2462 created the Office of General Inspection. - Dr.
Rosario Pastor a lady physician was headed the Office of District Nursing. - Two
graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs. Matilde Azurin
were employed for Maternal and Child Health and Sanitation in Manila under
an American nurse, Mrs. G.D. Schudder.
∙ 1915 – PHN began in Manila with 2 nurses who offered follow-up care of OB
patients and environmental sanitation services
∙ 1919 – The first Filipino nurse Supervisor under the Bureau of Health, Miss
Carmen del Rosario was appointed. She succeeded Miss Mabel Dabbs. ∙ 1923
- Two government Schools of Nursing were established: Zamboanga General
Hospital School of Nursing in Mindanao and Baguio General Hospital in
Northern Luzon. These schools were primarily intended to train non-Christian
women and prepare them to render service among their people.
- Four more government School of Nursing were establish: one in Southern
Luzon (Quezon Province) and three in the Visayan Islands of Cebu, Bohol and
Leyte.
∙ 1927 – The Office of District Nursing under the Office of General Inspection,
Philippine Health Service was abolished and supplanted by the Section of Public
Health Nursing. Mrs. Genara de Guzman acted as consultant to the Director of
Health on nursing matters.
∙ 1928 – First convention of nurses was held followed by yearly conventions until the
advent of World War II. Pre-service training was initiated as a pre-requisite for
appointment.
∙ 1930 – The Section of Public Health Nursing was converted into Section of Nursing.
The Section of Nursing was transferred from the Office of General Services to the
Division of Administration. This Office covered the supervision and guidance of
nurses in the provincial hospitals and the government schools of nursing.
∙ 1933
- Reorganization Act No. 4007 transferred the Division of Maternal and Child
Health of the Office of Public Welfare Commission to the Bureau of Health. -
Mrs. Soledad A. Buenafe, former Assistant Superintendent of Nurses of the
Public Welfare Commission was appointed as Assistant Chief Nurse of the
Section of Nursing, Bureau of Health.
∙ 1941
- Bureau of Health were transferred to the new department.
 - Dr. Mariano Icasiano became the first City Health Officer of Manila. - An
office of Nursing was organized with Mrs. Vicenta C. Ponce. As Chief Nurse and
Mrs. Rosario A. Ordiz as Assistant Chief Nurse.
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∙ Dec 8. 1941 - World War II broke out, public health nurses in Manila were
assigned to devastated areas to attend to the sick and the wounded.
∙ 1942
- A group of public health nurses, physicians and administrators from the Manila
Health Department went to the internet camp in Capas, Tarlac to receive sick
prisoners of war released by the Japanese Army.
- They were confined at San Lazaro Hospital and 68 Public Health Nurses were
assigned to help the hospital staff take care of them.
∙ July 1942
- 31 nurses who were taken prisoners of war by the Japanese army and confined
at the Bilibid Prison in Manila were released to the Director of the Bureau of
Health, Dr. Eusebio Aguilar who acted as their guarantor.
- Many public health nurses joined the guerillas or went to hide in the
mountains during World War II.
3) Japanese Regime (1942-1945)
∙ PHN services were interrupted
4) Era of the Republic of the Philippines (1946 to present)
∙ February 1946
- Post war records of the Bureau of Health showed that there were 308 public
health nurses and 38 supervisors compared to pre-war when there were 556
public health nurses and 38 supervisors.
- Mrs. Genera M. de Guzman, Technical Assistant in Nursing of the Department
of Health and concurrent President of the Filipino Nurses Association
recommended the creation of a Nursing Office in the Department of
Health ∙ 1947 DOH was divided into 3 bureaus: Hospital, Quarantine & Health ∙
Oct. 7, 1947
- Executive Order No. 94 organized government offices and created the Division
of Nursing under the Office of the Secretary of Health. This was implemented
on December 16, 1947.
- Mrs. Genara de Guzman was appointed as Chief of the Division, with three
Assistant: Miss Annie Sand for Nursing Education; Mrs. Magdalena C.
Valenzuela for Public Health Nursing and Mrs. Patrocinio J. Montellano for
Staff Education.
- At the Bureau of Health, the Section of Nursing Supervision took over the
functions of the former Section of Nursing. - Mrs. Soledad Buenafe was
appointed Chief and Miss Marcela Gabatin, Assistant Chief.
∙ 1948
- The first training Center of the Bureau of Health was organized in cooperation
with the Pasay City Health Department. This was housed at the Tabon Health
Center located in a marginalized part of the city. It was later renamed as Doña
Marta Health Center.
- Physicians and nurses undergoing pre-service and in-service training in public
health/public health nursing as well as nursing student on affiliation were
assigned to the above training center.
∙ 1950
- The Rural Health Demonstration and Training Center (RHDTC) was established
 by the Department of Health through the initiative of Dr. Hilario Lara, Dean,
institute of Hygiene, now College of Public Health, University of the
Philippines.
- The WHO/UNICEF assisted project used health centers of the Quezon City
Health Department, which were located in the rural areas of the city.
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- Dr. Amansia S. Mangay (Mrs. Andres Angara), a Doctor of Public Health

Graduate from Harvard was chosen to be the Chief of the RHDTC.
- Dr. Antonio V. Acosta, former Physician of the Manila Health Department was
Medical Training Officer.
∙ 1953 - The Office of Health Education and Personnel Training was established with
Dr. Trinidad Gomez as Chief - Philippine Congress approved Republic Act No. 1082
or the Rural Health Law. It created the first 81 Rural Health Units.
∙ May 18, 1954 – RA 1082 (RHU Act) was passed, implemented in July of the same
year, provided for the employment of health personnel, including nurses, who
would man the RHUs and help raise the health conditions of the rural population.
∙ 1957 – Republic Act 1891 was approved amending Sections Two, Three, Four,
Seven and Eight of R.A. 1082: Strengthening Health and Dental Services in the
Rural Areas and Providing Funds thereto.”
∙ June 1957 – RA 1891 (An Act Strengthening Health and Dental Services in the
Rural Areas and Providing Funds Thereof) was approved; created eight (8)
categories of RHUs corresponding to 8 population groups to be served.
∙ 1958-1965
- Republic Act 977 passed by Congress in 1954 was implemented. This abolished
the Division of Nursing. However, it created nursing positions at different levels
in the health organization. Miss Annie Sand was appointed Nursing Consultant
under the Office of the Secretary of Health.
- The Department of Health National League of Nurses, Inc. was founded by Miss
Annie Sand in 1961. She became its first President and Adviser.
- The Reorganization Act with implementing details embodied in Executive
Order 288, series of 1959 de-centralized and integrated health services.
- The reorganization of 1959 also merged two Bureaus in the Department of
Health. The Bureau of Health was merged with the Bureau of Hospitals to form
the Bureau of Health and Medical Services.
∙ 1967
- In the Burea of Disease Control, Mrs. Zenaida Panlilio
- Nisce was appointed as Nursing Program Supervisor and served as consultant
on the nursing aspects of the 5 special diseases: TB, Leprosy, Venereal Disease,
Cancer, Filariasis, and Mental Health.
∙ 1974 – The Project Management Staff was organized as part of Population II of the
Philippine Government with Dr. Francisco Aguilar as Project Manager.
∙ 1975 – Formulation of the National Health Plan and the restructured Health Care
Delivery System.
∙ 1992 – Devolution transferred authority to LGU by virtue of the Local Government
Code. Appointments of RHU/City Health Department personnel (including nursing
personnel) have to be approved by the mayor. Material supplies of health center
have to be provided by the LGUs.

9. Roles and Responsibilities of a Community Health Nurse

ROLES FUNCTIONS
1. Planner/Programmer - Identifies needs, priorities and problems of individuals, families
and community
- Formulates nursing component of health plans, In doctorless
area, she/he is responsible for the formation of the municipal
health plan - Interprets and implements the nursing plan,
program policies,

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memoranda and circulars for the concerned staff/personnel -
Provides technical assistance to rural health midwives in
health matters like target setting, etc.

2. Provider of - Provides direct nursing care to the sick, disabled in the home,
Nursing Care clinic, school or place of work.
- Develops the family’s capability to take care of the sick, disabled
or dependent member.
- Provides continuity of patient care

3. Manager/Supervisor - Formulates individual, family, group and community centered

care plan.
- Interprets and implements program policies, memoranda
and circulars.
- Organizes work force, resources, equipment and supplies,
and delivery of health care at local levels
- Requisitions, allocates, distributes materials (medicine and
medical supplies, records and reports equipment)
- Provides technical and administrative support to Rural Health
Midwife (RHM)
- Conducts regular supervisory visits and meetings to different
RHMs and gives feedback on accomplishments/performances.

4. Community Organizer - Responsible for motivating and enhancing community participants

in terms of planning, organizing, and implementing and evaluating
health programs/services
- Initiates and participates in community development activities

5. Coordinator - Coordinates with individuals, families, and groups for health and
related health services provided by various members of health
team and other Government Organizations (GOs) and
Non-Government Organizations (NGOs)
- Coordinates nursing program with other health programs as
environmental sanitation, health education, dental health and
mental health.
6. Trainer/Health - Identifies and interprets training needs of the RHMs, Barangay
Educator/Counselor Health Workers (BHWs) and hilots.
- Formulates appropriate training program designs for RHMs,,
BHWs and hilots
- Provides and arranges learning experience for RHMs,
affiliates (nursing and midwife) and other health workers.
- Conducts training for RHMs and hilots on health promotion
and disease prevention
- Conducts pre and post consultation conferences for clinic
patients - Facilitates training for Barangay Health Worker
- Organizes orientation/training of concerned groups including
non government organizations
- Acts as a resource speaker/person on health and health
related services
- Participates in the development and distribution of
Information Education and Communication (IEC) materials
- Conducts IEC orientation for selected group in
specific programs/projects
- Initiates the use of radio/TV and cinema plugs, print ads and
other indigenous resources for health education purposes

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- Conducts pre-marital counseling
Counseling – is the process of helping a client to recognize and
cope a stressful psychological or social problems, to develop
improved intrapersonal relationships, promote personal growth

7. Health Worker - Detects deviation from health of individuals, families, groups of

the community through contact/visits with them.
- Uses symptomatic and objective observation and other forms of
data gathering like morbidity, registry, questionnaire, checklist, and
anecdo, report/ record to monitor growth, development, and
health status of individuals, families, and communities

8. Role Model - Provides good example/model of healthful living in

the public/community

9. Change Agent - Motivates changes in health behavior of individuals, families, group

an community including lifestyle in order to promote and maintain
health.

10. - Prepares and submits required reports and records

Recorder/Reporter/ - Maintains adequate, accurate and complete recording and
Statistician reporting. - Reviews, validates, consolidates, analyzes and
interprets all records and reports
- Prepares statistical data/charts and other data presentation
for display and presentation in staff meetings, conference,
seminars/workshops.
 11. Researcher - Participates/assists in the conduct of surveys studies and
researches in nursing and health related subjects
- Coordinates with gov’t. and non-gov’t. organization in
the implementation of studies/research

References for the OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

American Public Health Association, Public Health Nursing Section. (2013). The definition and practice of
public health nursing: a statement of the public health nursing section. Washington, DC:
American Public Health Association.
Arkansas State University Academic Partnerships. (2017). What is a Community Health Nurse? Retrieved
from https://degree.astate.edu/articles/nursing/community-health-nurse.aspx
Brooks, A. (2019). What is community health and why is it important? Retrieved from
https://www.rasmussen.edu/degrees/health-sciences/blog/what-is-community-health/
Cuevas, F. P. (2007). Public health nursing in the Philippines. Philippines.
Santos, E. & Santos, H. P. (2004). History of public health & public health nursing. Retrieved from
http://www.authorstream.com/Presentation/geethujerald-1542374-history-public-health
nursing-1/
University of Pittsburgh Graduate School of Public Health. (2019). Public health. Retrieved from
https://www.publichealth.pitt.edu/careers/what-is-public-health
World Health Organization. (2018a). State of global health. Retrieved from https://www.who.int/news
room/facts-in-pictures/detail/state-of-global-health
World Health Organization. (2018b). Country cooperation strategy at a glance. Retrieved from
https://apps.who.int/iris/bitstream/handle/10665/136828/ccsbrief_phl_en.pdf;jsessionid=F5F
1 E9C727F1109E6448A0B349BEF1D5?sequence=1