Health manpower to population ratio
greater sharing of research evidence, tools, and materials
1. Population - total number of individuals in a territory
constituting a particular race, class, or group.
2. Barangay - the barrio, smallest local government unit in the
Philippines and is the native Filipino term for a village,
3. Household - is a social unit consisting of a person living alone or
a group of persons who: 1. sleep in the same housing unit; and 2.
have a common arrangement for the preparation and consumption
of food
4. Health center - refers to a health facility which provides basic
clinical, preventive, promotive, curative, and rehabilitative
services for the municipality/city such as a Municipal Health
Center (MHC), City Health Center (CHC) and Rural Health
Unit (RHU)
5. Barangay Health Stations - satellite health facility of the
mhc/chc that provides primary health care.
6. Ratio of Public Health Worker to Population: Total No. of
Health Personnel / Population
7. Health personnel hired by the LGU or hired through the Human
Resource for Health (HRH) Deployment Program, either as
permanent, job order, casual, contractual with at least one (1)
year in service: (notebook)
(RA1364) - Board of Examiners for Sanitary Engineers
III. The Health Care Delivery System
Nation’s Health Care Delivery System
 Has a tremendous impact on the health of its people and their
socioeconomic status. 
Factors that influence health care delivery system
 Health care “reforms” , Demographics, Globalization, Poverty
and growing disparities, Social disintegration
World Health Organization provides global leadership on health matters.
 In PH, health services are provided by the government and the
private sector –for profit as well as nonprofit, with the latter
frequently referred to as nongovernmental organizations or
NGO’s.
o In the national level, director is set by department of
health (DOH) by virtue of mandate of the Local
Government Code (R.A.7160) LGU’s should have
operating mechanism to meet the priority needs and
service requirements of their communities.
A Health System consists of all organizations, peoples, and actions whose
primary intent is to promote, restore, or maintain health.
 A health system has six building blocks or components:
1. Service delivery
2. Health workforce
3. Information
4. Medical products, vaccines, and
technologies  health professionals in the Philippines.
5. Financing
6. Leadership and governance or Stewardship
01. The World Health Organization
The WHO constitution came into force on April 7, 1948.
● April 7 has been celebrated each year as World Health Day
WHO CORE FUNCTIONS:
1. Providing leadership on matters critical to health and engaging
partnerships where joint action is needed.
2. Shaping the research agenda and stimulating the generation, translation,
and disseminating valuable knowledge.
 Capacity –to strengthen the national health research system
 Priorities – To focus research on priority health need
particularly in low and middle-income countries
 Standards - To promote good research practice and enable the
 Translation - To ensure that quality evidence is turned into
products and policy
 Organization – To strengthen the research culture within WHO
and improve the management and coordination of WHO research
activities.
3. Articulating ethical and evidence-based policy options.
4. Providing technical support, catalyzing change, and building sustainable
institutional capacity.
02. The Millenium Development Goals (MDGs)
September 6 to 8, 2000 – World leaders on UN General Assembly
participate in Millennium Summit.
The declaration expressed the commitment of the 191 member states,
including the Philippines, to reduce extreme poverty and achieve seven
other targets - now called the Millennium Development Goals (MDGs)
by the year 2015 :
1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child mortality - reduce by 2/3,
5. Improve maternal health - Reduce by three-quarters
6. Combat HIV/AIDS, malaria, and other diseases.
7. Ensure environmental sustainability
8. Develop a global partnership for development
03. The Philippine Health Care System
The DOH - main governing body of health services in the country.
● Provides guidance and technical assistance to LGUs (17 regions.)
Provincial governments - Responsible for administration of provincial and
district hospitals.
Municipal and City Governments
 In charge of primary care through rural health units (RHUs) or
health centers.
 Satellite outposts known as barangay health stations (BHSs)
provide health services in the periphery of the municipality or
city.
The private sector - for-profit and nonprofit agencies, provides all levels
of services and accounts for a large segment of health service providers in
the country.
● 30% of Filipinos - private health facilities, 60% of national health
expenditure goes to the private sector which employs more than 70% of the
Financing of health services is provided by 3 major groups:
 The Government (National and Local)
 Private Sources
 Social Health Insurance
National Insurance Act of 1995 (R.A. 7875)
 Created by the Philippine Health Insurance Corporation
(PhilHealth).
 It is tax-exempt government corporation attached to the DOH for
policy coordination and guidance and aims for universal health
coverage of all Filipino citizens.
04 The Department Of Health
Vision - “Filipinos are among the healthiest people in Southeast Asia by
2022, and Asia by 2040”
 To be a global leader for attaining better health outcomes,
competitive and responsive health care system, and equitable
health financing.
Mission - “To lead the country in the development of a productive,
resilient, equitable and people-centered health system”
 To guarantee equitable, sustainable and quality health for all
Filipinos, especially the poor, and to lead the quest for excellence
in health.
In the pursuit of its vision and execution of its mission, the ff. has the major
roles:
1. Leader in health
2. Enabler and capacity builder
3. Administrator of specific services
DOH core values
Integrity, Excellence, Compassion and respect for human dignity,
Commitment, Professionalism, Teamwork, Stewardship of Health, Political
Neutrality, Simple living
LEVELS OF HEALTH CARE DELIVERY
● Administrative order 2012-0012 (Rules and Regulations Governing the
new Classification of Hospitals and Other Health Facilities in the
Philippines) - provides for a new classification scheme of health facilities.
Hospitals Other Health Facilities
Level 1 A. Primary Care facility
Level 2 B. Custodial facility
Level 3 (teaching/ training) C. Diagnostic/Therapeutic facility
Specialty D. Specialized outpatient facility
CATEGORY A: PRIMARY HEALTH CARE FACILITY
 first contact health care facility that offers basic service including
emergency services and provision for normal deliveries.
 Devolved to cities and municipalities
 Center physicians, public health nurses, rural health midwives,
traditional healers.
1. Without in-patient beds like health centers, out-patient clinics,
and dental clinics.
2. With in-patient beds – a short-stay facility where the patient
spends on the average of one to two days before discharge.
Ex: Infirmaries and birthing (Lying-in) facilities.
CATEGORY B: CUSTODIAL CARE FACILITY
 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
 health facilities either privately owned or government-operated.
Ex: Custodial health care facilities, substance/drug abuse
treatment and rehabilitation centers, sanitaria, leprosaria, and
nursing homes.
CATEGORY C: DIAGNOSTIC/ THERAPEUTIC FACILITY
 examination of the human body, specimens from the human body
for the diagnosis
 Provided complicated cases and intensive care. - The test
covers the preanalytical, analytical and post analytical phases of
examination
CATEGORY D: SPECIALIZED OUTPATIENT FACILITY
A facility that performs highly specialized procedures on an outpatient
basis.
Ex: Dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic
center/clinic, cancer radiation facility, and physical medicine and
rehabilitation center/clinic.
05 The Rural Health Unit
 a primary level health facility in the municipality.
 RHU focuses on preventive and health services
 Supervise BHSs under its jurisdiction
Barangay Health Station (BHS)
 first-contact health care facility, offers basic services at Barangay
 It is a satellite station of RHU
 It is manned by volunteer Barangay Health Workers (BHWs)
under the supervision of the Rural Health Midwife (RHM)
(DOH, 2001).
Barangay Health Workers (BHWs)
 equipped with basic skills for prevention and management of
common diseases.
 They assist in providing basic services at the BHS and the RHU
 Accredited by the local health board acc. to DOH guidelines
 According to R.A. 7883 or the Barangay Health Workers’
Benefit and Incentive Act, a hazard and subsistence allowances
and other benefits are given to them
The Rural Health Unit Personnel
The Municipal Health Unit Personnel (MHO) or Rural Health Physician
heads the health services at the Municipal Level Roles and functions:
1. Administrator of the RHU
2. Community Physician
3. Medico-legal officer of the Municipality (DOH, 2001)
● According to R.A. 7305 or the Magna Carta of Public Health Workers,
there be (1) rural health physician to a population of 20,000 (DOH, 1999).
Local Health Boards
● R.A 7160 or Local Government Code o enacted to bring about genuine
and meaningful local autonomy.
● R.A 7160 provided for the creation of the Provincial Health Board and
the City/Municipal Health boards, or Local Health Boards
● It mandates devolution of basic services from the national government to
LGUs.
● This will enable local governments to attain their fullest development as
self-reliant communities and make them more effective partners in the
attainment of national goals.
Functions of Local Health Boards
1. Proposing to the Sanggunian annual budgetary allocations for the
operation and maintenance of health facilities and services.
2. Serving as an advisory committee to the Sanggunian on health matters;
and
3. Creating committees that shall advise local health agencies
Health Referral System - A referral is a set of activities undertaken by a
health care provider or facility in response to its inability to provide the
necessary health intervention to satisfy a patient’s need.
FUNCTIONAL REFERRAL SYSTEM
 Ensures the continuity and complementation of health and
medical services
 It usually involves movement of a patient from the health center
of first contact and the hospital at first referral level.
 When hospital intervention has been completed, the patient is
referred back to the health center. This accounts for the term two-
way referral system.
Internal Referrals - Occur within the health facility.
● May be made to request for an opinion or suggestion, co-management, or
further management or specialty care.
External Referrals - A movement of a patient from one health facility to
another.
● It may be vertical, where the patient referral may be from a lower to a
higher level of health facility or the other way round.
The Inter - Local Health Zone – Provides a means for consolidating
health care efforts.
 The ILHZ is based on the concept of the District Health System -
A generic term used by WHO to describe an integrated health
management and delivery system based on a defined
administrative a geographical area.
 An ILHZ has a defined catchment population within a defined
geographical area, it has a central or core referral hospital and a
number of primary level facilities such as RHUs and BHSs.
The ILHZ has the following components: People, Boundaries, Health
facilities, Health workers
06 Health Sector Reform: Universal Health Care
● Also Called the Aquino Health Agenda
● It is the latest in a series of continuing efforts of the government to bring
about health sector reforms.
● UHC was built upon strategies of two previous platforms of reform: ○
The Initial health Sector Reform Agenda ○ FOURmula One for Health
Goals and Objectives :
 Better health outcomes.
 Sustained health financing
 A responsive health system by ensuring that all Filipinos,
especially the disadvantaged group, have equitable access to
affordable health care.
The attainment of the goal of UHC is through the pursuit of three strategic
thrusts:
 Financial risk protection through expansion in NHIP enrollment
and benefit delivery
 Improved access to quality hospitals and health care facilities
 Attainment of the health-related MDGs
To achieve the three strategic thrusts, six strategic instruments shall be
optimized:
 Health Financing
 Service Delivery
 Policy, Standards, and Regulation
 Governance for Health
 Human Resources for Health
 Health Information
Public Health Programs
1. Reproductive and Maternal Health
2. Expanded Garantisadong Pambata (child health)
3. Control of communicable disease
4. Control of Noncommunicable or Lifestyle Diseases
5. Environmental Health
IV. THE PUBLIC HEALTH NURSE
Public health nurses are found in various health settings and occupying
various positions in the hierarchy. They are assigned in:
● Rural Health Units ● City Health Centers ● Provincial Health Offices ●
Regional Health Offices ● National Office of the DOH ● Public schools
● Offices of government agencies providing health care services - They
occupy a range of positions from Public Health Nurse I to Nurse Program
Supervisors to Chief Nurse in public health settings
 The Public Health Nurse uses various tools and procedures
necessary for them to properly practice their profession and
deliver basic health service.
 They use nursing process in their practice and is adept in
documenting and reporting accomplishments through records and
reports.
 Public health nurses are also technically competent in various
nursing procedures conducted in settings where they are
assigned.
01. QUALIFICATIONS AND FUNCTIONS
The Public Health Nurse must be professionally qualified and licensed to
practice in the arena of public health nursing just like any other
professional health worker.
A public health nurse needs the personal qualities and "people skills"
necessary to make a real difference in the lives of the people they
encounter.
For qualifications, this is where physical, mental and emotional strength
will be needed; where
● Leadership, ● Resourcefulness, ● Creativity, ● Honesty, ● Integrity will
be tested. ● Interest, ● Willingness, ● Capacity to work with people will
spell the difference between a token performance and making a difference
in the lives of people.
The Public Health Nurse functions
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.
FIVE MANAGEMENT FUNCTIONS 1. Planning 2. Organizing 3.
Staffing 4. Directing 5. Controlling
This function is performed when she organizes the "nursing service" of the
local health agency.
PROGRAM MANAGEMENT FUNCTION
 As a program manager she is responsible for the delivery of the
package of services provided by the program to the target
clientele.
 As a program manager they plan activities and sets targets,
organizes, directs and control activities and outputs, deploys
 needed manpower such as midwives and budgets resources
accordingly. ○
 Reports on program accomplishments is a documentation of her
management skills.
Supervisory Function
 The public health nurse is the supervisor of the midwives and
other auxiliary health workers in the catchment area.
 As a supervisor she formulates a supervisory plan and conducts
supervisory visits to implement the plan.
 She conducts supervisory visits using a supervisory checklist The
Sentrong Sigla Program has developed a Supervisory Package
complete with supervisory checklists for various programs and
proved to be useful to supervisors.
NURSING CARE FUNCTION
 She does assessment, plans and implements care, and evaluates
outcomes.
 She establishes rapport with her client,
 Home visits are must activities of the PHN because it is a visible
manifestation of her caring function.
 Referral of patients to appropriate levels of care should be done
when indicated. From an assessment, the nurse may discover
health problems that are outside the scope of nursing practice but
require attention.
COLLABORATING AND COORDINATING FUNCTION
 They are actively involved both socially and politically to
empower individuals, families and communities as an entity to
initiate and maintain health promoting environments.
 She establishes linkages and collaborative relationships with
other health professionals, government agencies, the private
sector, non-government organizations, people's organizations to
address health problems.
 She identifies persons, groups, organizations, other agencies and
communities whose resources are available within and outside
the community
 Her established linkages enables her to appropriately refer
patients to other health personnel, health facility or government
agency.
HEALTH PROMOTION AND EDUCATION FUNCTION
She understands that health is determined by various factors such as
physical and political environment, socio-economic status, personal coping
skills and many other circumstances
The PHN understands the multidimensional nature of health to enable her
to plan and implement health promoting interventions for individuals and
communities
The PHN uses her skills in advocacy for the creation of a supportive
environment through policies and reengineering of the physical
environment for healthier actions.
TRAINING FUNCTION
The public health nurse initiates the formulation of staff development and
training programs for midwives and other auxiliary workers.
She also does evaluation of training outcomes.
She participates in teaching, guidance and supervision of student affiliates
for their related learning experiences in the community setting.
RESEARCH FUNCTION - conduct of research and utilizes research
findings in her practice.
DISEASE SURVEILLANCE - a research activity of the nurses. It is a
continuous collection and analysis of data of cases and deaths. The
purposes of disease surveillance are: (1) to measure the magnitude of the
problem and (2) to measure the effect of the control program.
It is important in monitoring the progress of the disease reduction
initiatives: Poliomyelitis Eradication, Neonatal Tetanus Elimination,
Measles Control, NCD risk factors, etc.
- The data collected can be used to improve strategies and thus prevent
these diseases from occurring.
Illustration of an actual performance of function of a Public Health
Nurse in a City Health Office
The Public Health Nurse II
 The Public Health Nurse II works in a health center where she is
the frontline health worker and prime mover for all health
programs and activities.
 She is the first contact of the patient in the health center, where
she screens cases according to established program protocol.
 She only refers cases to physicians when it is not within her
responsibilities to manage.
 She assists the physician during consultation and examination
and gives treatments to patients.
 She provides health education to the public by giving pre and
post clinic lectures, reaching out to the community.
 She performs home visits or follow-up cases that requires nursing
care and teaches the family members to give care to the sick.
 She has to prepare and submit the necessary reports required of
her, which are done weekly, monthly, quarterly or annually.
The Public Health Nurse III
 The PHN III performs the same functions but differs from the
PHN II in the sense that when they are assigned in the same
health center, the PHN III acts as the nurse-in-charge.
 She supervises, guides, coordinates and evaluates the work of her
nurses.
 She likewise interprets policies and participates in planning
health programs or activities that involves nursing service.
Nurse V
 known as the "Supervising Public Health Nurse", is assigned in a
health center with a lying-in clinic, and takes charge of the unit,
with several staff members,
 She supervises and coordinates the work of nurses, midwives and
other health personnel and guides them
 She participates in program planning, provides training and
guidance to in-service trainees and student affiliates. She attends
meetings, conferences or seminars for her own career growth and
for the improvement of health services.
 Evaluate the performance of her staff and analyze records and
reports.
Nurse Program Supervisor or Nurse VI
 Manages and oversees the performance of a group of nurses
 performing consultations and objective assessment and
evaluation of nursing programs, problems and services.
 She consolidates / evaluates and analyzes the necessary weekly,
monthly, quarterly and annual reports of the health center.
 She studies and evaluates the performance ratings of nurses.
 She initiates meetings, discussions and conferences
 She conducts program orientation to pre-service and in-service
nurse trainees and students and coordinates with other health
disciplines in the implementation of programs.
02 COMPETENCIES, SKILLS, AND KNOWLEDGE OF A PUBLIC
HEALTH NURSE
COMMUNITY HEALTH NURSING PROCESS
● is a systematic, rational method and providing nursing care for the
prevention of disease and promotion of health of the community.
● composed of Assessment, Diagnosis, Planning, Implementation, and
Evaluation (ADPIE)
STEPS IN COMMUNITY HEALTH NURSING PROCESS
1. Establishing and maintaining working relationship - In “working
relationship”, there is a free dialoguing and an attitude of trust and
confidence in the integrality and capabilities of each other to meet health
and nursing goals.
2. Assessment of Health needs and Health problems - comes to know the
health needs and problems and she explores the community.
3. Setting Objectives - Once the problems are prioritized, it is very
important to set up objectives relevant to each of the problems identified.
4. Planning and Implementations of Interventions - Various action are
decided and implemented as being most effective in order to solve
particular problems.
5. Evaluation of Action Plan - Evaluation of interventions determines the
effectiveness of actions implemented- whether the desired results intended
are achieved or not.
NURSING PROCEDURES DURING CLINIC AND HOME VISITS
● Clinic Visit- process of checking the client’s health condition in a
medical clinic.
● Home Visit- a professional face to face contact made by the nurse with a
patient or the family to provide necessary health care activities
● Bag Technique- a tool making of the public health bag through which the
nurse during the home visit can perform nursing procedures
● Thermometer Technique- to assess the client’s health condition through
body temperature reading
● Nursing Care in the home- giving to the individual patient the nursing
care required by his/her specific illness or trauma
COMMUNITY ORGANIZING - Community organizing is the process of
building power through involving a constituency in identifying problems
they share and the solutions to those problems that they desire.
7 STEPS OF COMMUNITY ORGANIZING 1. Integrate into the
community 2. Identify issues impacting the community 3. Set goals and
objectives 4. Identify individuals and create core groups 5. Create an action
plan to meet goals 6. Execute and monitor the action plan 7. Evaluate the
effect of action plan on the stated goals
HEALTH PROMOTION AND EDUCATION
● Public Health Nurses spend the most time with the patients and provide
anticipatory guidance about immunizations, nutrition, dietary, medications,
and safety
● They do this through a variation of tactics that include education, risk
factor prevention, and the monitoring of safety hazards either in the
workplace, community, or home.
SURVEILLANCE
● monitoring crucial health status indicators such as environmentally
caused illnesses, immunization levels, infant mortality rates, and
communicable disease occurrence,
RECORDS AND REPORTS
● Records - information kept in the health unit, information on
administrative, matters: staff, equipment, supplies, etc.
- written information in notebooks or in folders designed for their purposes.
They may also be kept or be computerized.
● Reports are done through oral or written in normal circumstances.
● Record and report are mutually interdependent. Report can be prepared
on the basis of records. Similarly the report can be presented as record.
Health record is a form of information procured from the individual, family
and community.
CORE COMPETENCIES OF PUBLIC HEALTH NURSE
● DATA ANALYTICS AND ASSESSMENT SKILLS - core
competencies needed to collect, assess, analyze and apply information
(including data, facts, concepts and theories).
● POLICY DEVELOPMENT AND PROGRAM PLANNING SKILLS
- core competencies needed to effectively choose options, and to plan,
implement and evaluate policies and/or programs in public health.
● COMMUNICATION SKILLS - addresses numerous dimensions of
communication including internal and external exchanges;
● HEALTH EQUITY SKILLS - captures the competencies required to
influence and work with others to improve the health and well-being of the
public through the pursuit of a common goal. This includes the concepts of:
social justice, which is the fair distribution of society’s benefits and
responsibilities and their consequences; to speak, write or act in favour
● COMMUNITY PARTNERSHIP SKILLS - This includes the concepts
of: social justice, partnership and collaboration; advocacy which is to
speak, write or act in favour of a particular cause and to reduce inequities in
health status.
● PUBLIC HEALTH SCIENCES SKILLS - This category includes key
knowledge and critical thinking skills related to: the public health sciences
as well as nursing theory, change theory, economics, politics, public health
administration, community assessment, management theory, program
planning and evaluation, population health principles, community
development theory, and the history of public health.
● MANAGEMENT AND FINANCE SKILLS - nurses are accountable
for their actions and are responsible for making sure they have the required
knowledge and skills needed to ensure the delivery of safe, compassionate,
competent and ethical care.
➔ Public Health nurses are responsible for initiating strategies that will
address the determinants of health and generate a positive impact on people
and systems.
➔ The development of financial management skills and competencies can
assist PHNs to better manage the current health care situation.
● LEADERSHIP SKILLS - This category focuses on leadership
competencies that build capacity, improve performance and enhance the
quality of the working environment. They also enable organizations and
communities to create, communicate and apply shared visions, missions
and values.
03 HEALTH PROMOTION AND COMMUNITY HEALTH NURSING
Green and Kreuter (1991) define health promotion as “any combination
of health education and related organizational, economic, and
environmental supports for behavior and individuals, groups, or
communities conducive to health”
Parse (1990) states health promotion as behavior that is motivated by the
desire to increase well-being and to reach the best possible health potential
OTTAWA CHARTER FOR HEALTH PROMOTION
Organized by the WHO, the first International Conference on Health
Promotion was held at Ottawa, Canada on November 17-21, 1986.
health promotion - the process of enabling people to increase control over,
and to improve their health, which requires that an individual or group must
be able to identify and realize aspirations, to satisfy needs, and to change or
cope with the environment.
Health is a positive concept emphasizing social and personal resources, as
well as physical capacities. health promotion is not just the responsibility
of the health sector, but goes beyond healthy lifestyles to well-being
Prerequisites for Health
1. Peace 2. Shelter 3. Education 4. Food 5. Income 6. A stable ecosystem 7.
Sustainable resources 8. Social justice and equity
Three basic strategies for health promotion:
1. Advocacy for health to provide for the conditions and resources essential
for health
2. Enabling all people to attain their full health potential
3. Mediating among the different sectors of society in efforts to achieve
health
Five priority actions areas provide support to theses three strategies:
1. BUILD HEALTHY PUBLIC POLICY - coordinated action that
combines diverse but complementary approaches including legislations,
fiscal measures, taxation, and organizational change.
2. CREATE SUPPORTIVE ENVIRONMENTS - Health promotion
generates living and working conditions that are safe, stimulating,
satisfying, and enjoyable.
3. STRENGTHEN COMMUNITY ACTIONS - Health promotion works
through concrete and effective community actions in setting priorities,
making decisions, planning strategies and implementing them to achieve
better health.
4. DEVELOP PERSONAL SKILLS - Enabling people to learn ,
throughout life, to prepare them for all of its stages and to cope with
chronic illness and injuries is essential.
5. REORIENT HEALTH SERVICES - require stronger attention to
health research as well as changes in professional education training. This
must lead to a change of attitude and organization of health services that
refocuses on the total needs of the individual as a whole person.
6. MOVING INTO THE FUTURE - those involved should take as a
guiding principle that, in each phase of planning, implementation, and
evaluation of health promotion activities, women and men should become
equal partners.
05 HEALTH EDUCATION
Health education is the process of changing people’s knowledge, skills,
and attitudes for health promotion and risk reduction.
Patient Education usually refers to a series of planned teaching-learning
activities designed for individuals, families, or groups with and identifies
alteration in health.
THE EFFECTIVE NURSE EDUCATOR
1. MESSAGE. The nurse needs to consider factors that may affect the
learner’s ability to receive and retain the information.
2. FORMAT. The strategy must match the objectives of the learning
activity and the characteristics of the learner. For example, a demonstration
of the procedure will be helpful in teaching a first-time mother how to
prepare solid foods for her 6-month old baby.
3. ENVIRONMENT Aside from having a physical environment
conducive to learning, the nurse must create a therapeutic and supportive
relationship with the learner. In a group setting, the nurse should foster
positive interpersonal relationships among the learners to allow them to
contribute to the attainment of learning objectives. In a structured health
educational activity, the nurse may have to attend to administrative aspects
of the learning environment, such as the schedule and materials.
4. EXPERIENCE - Sequencing of materials in a logical manner from
simple to more complex concepts allows building on previous learning.
5. PARTICIPATION - Depending on the objectives on the learning
session, the nurse applies methods such as these, knowing that active
involvement provides for better learning.
6. EVALUATION. Using tools such as quizzes, individual conferences,
and return demonstrations, the nurse may monitor and evaluate learning
outcomes. Knowing the degree of attainment of learning objectives
motivates learners to go on. At the same time, the nurse is able to identify
areas of instruction that may need to be modified.
06-07 COMPETENCY BASED-TRAINING OF
COMMUNITY/BARANGAY HEALTH WORKER
Community health workers (CHWs) - embrace a variety of community
health aides selected, trained, and working and carrying out functions
related to health care in the community where they reside. Their training
does not constitute tertiary education.
CHWs in the Philippines are known as the barangay health workers
(BHWs). As the supervisor of nursing auxiliary personnel, the public
health nurse participates in training volunteers who can work as BHWs.
goal of the training - volunteers’ development of competencies that will
enable them to provide primary care services.
requisite competencies of BHWs include communication, interpersonal,
teaching, organizational, advocacy skills, and knowledge about the
community (common illnesses and communicable diseases)
trained in providing health services, such as basic health assessment and
simple remedies for common health concerns.
Health assessment training includes taking vital signs, physical
assessment, and simple differential diagnostic techniques particularly
for areas where professional health workers may not be accessible. BHW
training also includes evidence-based home remedies for diarrhea, acute
respiratory infectious, and febrile conditions.
V. LEGISLATIONS AFFECTING COMMUNITY HEALTH
NURSING PRACTICE
LAWS, EXECUTIVE ORDERS & LETTERS OF INSTRUCTIONS,
AND DOH CIRCULARS/MEMORANDA
Health Dental Health
Family Planning Environmental and Sanitation Health
Maternal Care Human Immunodeficiency Virus &
TUberculosis
Child Care Communicable & Non-Communicable
Disease
Universal Healthcare COVID-19 Surveillance and Vaccination
Act
01 HEALTH Is the absence of disease, injury and impairment.
REPUBLIC ACT – an act passed by the Congress of the Philippines,
while the form of government is Republican government.
LETTER OF INSTRUCTION – An order issued by the President to
serve as a guide to his/her previous decree or order.
EXECUTIVE ORDER – an order issued by the executive branch of the
government in order to implement a constructional mandate or a statutory
provision.
Universal health care act R.A. 11223 - The law mandates that most
Filipinos—the entire population as much as possible especially the “poorest
of the poor”—should be covered by health insurance.
National Health Insurance Act of 2013 RA 10606 - aims to provide
health insurance coverage and ensures access to cost-effective and quality
health care services for all Filipinos.
REPUBLIC ACT 10354 - An act providing for a national policy on
Responsible Parenthood and Reproductive Health
REPUBLIC ACT NO. 7875 - NATIONAL HEALTH INSURANCE ACT
OF 1995 An act instituting a national health insurance program for all
filipinos and establishing the Philippine Health Insurance Corporation for
the purpose.
Executive Order No. 155, s. 2021 - FURTHER IMPROVING ACCESS
TO HEALTHCARE THROUGH THE REGULATION OF PRICES IN
THE RETAIL OF DRUGS AND MEDICINES
Letter of Instruction No. 949, s. 1979 October 19, 1979 – Letter of
Instruction (LOI) 949, the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos, which adopted PHC as an approach towards the
design, development and implementation of programs focusing on health
development at community level.
02 FAMILY PLANNING & MATERNAL AND CHILD CARE
1. Republic Act No. 10354: Responsible Parenthood and Reproductive
Health Act of 2012 (RPRH Law)
2. Executive Order No. 12, s. 2017: Attaining and Sustaining “Zero Unmet
Need for Modern Family Planning” Through the Strict Implementation of
the Responsible Parenthood and Reproductive Health Act, Providing Funds
Therefor, and for other Purposes
3. Department Memorandum 2015-0384: Establishment of the Family
Planning Logistics Hotline
4. Executive Order No. 003:
5. Republic Act 11148: Nutrisyon at Kalusugan ng Mag-nanay Act
6. Republic Act 7600: AN ACT PROVIDING INCENTIVES TO ALL
GOVERNMENT AND PRIVATE HEALTH INSTITUTIONS WITH
ROOMING-IN AND BREASTFEEDING PRACTICES AND FOR
OTHER PURPOSES
7. Executive Order No. 51, s. 1986: National Code of Marketing of
Breastmilk Substitutes, Breastmilk Supplements and Other Related
Products
04 DENTAL HEALTH
RA 9484/RA 768/4419 - AN ACT TO REGULATE THE PRACTICE OF
DENTISTRY, DENTAL HYGIENE AND DENTAL TECHNOLOGY IN
THE PHILIPPINES, AND FOR OTHER PURPOSES
05 ENVIRONMENTAL & SANITATION HEALTH
1. REPUBLIC ACT 9003 ECOLOGICAL SOLID WASTE
MANAGEMENT ACT OF 2000
2. REPUBLIC ACT 9275 PHILIPPINE CLEAN WATER ACT OF
2004
3. REPUBLIC ACT 8749 PHILIPPINE CLEAN AIR ACT OF 1999
4. REPUBLIC ACT 6969 TOXIC SUBSTANCES, HAZARDOUS
AND NUCLEAR WASTE CONTROL ACT OF 1990
5. PRESIDENTIAL DECREE 1586 ENVIRONMENTAL IMPACT
STATEMENT (EIS) STATEMENT OF 1978
06. HIV AND TUBERCULOSIS
Republic Act No. 11166- (hiv) and (aids) prevention, treatment, care, and
support,
REPUBLIC ACT NO. 8504 - An act promulgating policies and
prescribing measures for the prevention and control of HIV/Aids in the
Philippines
Republic Act (RA) No. 10767 - entitled “An Act Establishing a
Comprehensive Philippine Plan of Action to Eliminate Tuberculosis as a
Public Health Problem and Appropriating Funds Therefor”
Executive Order No. 187, s. 2003 - INSTITUTING A
COMPREHENSIVE AND UNIFIED POLICY FOR THE
TUBERCULOSIS CONTROL IN THE PHILIPPINES
07 COMMUNICABLE AND NON-COMMUNICABLE DISEASE
REPUBLIC ACT No. 11332 - An Act Providing Policies and Prescribing
Procedures on Surveillance and Response to Notifiable Diseases,
Epidemics, and Health Events of Public Health Concern,
Republic Act 3573 - “An Act Which Provides for the Prevention and
Suppression of Dangerous Communicable Diseases”
Executive Order No. 168, s. 2014 - CREATING THE INTER-AGENCY
TASK FORCE FOR THE MANAGEMENT OF EMERGING
INFECTIOUS DISEASES IN THE PHILIPPINES
09 COVID-19 VACCINATION AND SURVEILLANCE
1. Republic Act No. 11494 “Bayanihan to Recover as One Act”
2. Presidential Decree No. 856 Promulgating the Code on Sanitation of
the Philippines.
Philippine Health Care Laws
1. Republic Act 1082 – Rural Health Unit Act
2. Republic Act 1891 – Act strengthening Health and Dental services in the
rural areas
3. Republic Act 4226 – Hospital Licensure Act requires all hospital to be
licensed before it can operative
4. Republic Act 6111 – Medicare Act
5. Republic Act 7875 – National Health Insurance Act of 1995
6. Executive Order 174 – National Drug Policy on Availability,
Affordability, Safe, Effective and Good Quality drugs to all
7. Republic Act No. 9502- An act providing for cheaper and quality
medicines, amending for the purpose
8. Republic Act No. 6675 or the Generics Act of 1988
VI. PRIMARY HEALTH CARE
The Alma, Ata Conference
 Health is a basic fundamental right.
 There exists global burden of health inequalities among
populations.
 Economic and social development is of basic importance for the
full attainment of health for all
 Governments have a responsibility for the health of their people.
Brief History of Primary Health Care (PHC)
September 6 -12 1978 - International Conference for Primary Health Care.
Alma Ata, USSR - Initiated by the WHO and United Nations Children’s
Fund
Letter of Instruction (LOI) 949 - In 1979, Philippines adopted the PHC
strategy. Philippines is the first country in Asia that adopted PHC.
Universal Goal - Health for All Filipinos and Health in the Hands of the
people by the Year 2020
PRIMARY HEALTH CARE - “is essential health care based on
practical, scientifically sound and socially acceptable methods and
technology made universally accessible to individuals and families in the
community through their full participation an at a cost that the community
and country can afford to maintain at every stage of their development in
the spirit of self-reliance and self-determination”
Key elements to achieving the goal of “Health for all”
 Reducing exclusion and social disparities in health (universal
coverage)
 Organizing health services around people’s needs and
expectations (health service reforms)
 Integrating health into all sectors (public policy reforms
 Pursuing collaborative models of policy dialogue (leadership
reforms)
 Increasing stakeholder participation
Eight essential health services according to the Alma, Ata declaration
 Education for health
 Locally endemic disease control
 Expanded program for immunization
 Maternal and child health including responsible parenthood
 Essential drugs
 Nutrition
 Treatment of non- and communicable diseases
 Safe water and sanitation
KEY PRINCIPLES OF PRIMARY HEALTH CARE
The key principles that set PHC apart from the traditional mode of health
care delivery are:
● Accessibility, affordability, acceptability, and availability
● Support mechanism
● Multisectoral approach
● Community participation
● Equitable distribution of health resources
● Appropriate technology
4 As of Public Health Care
Accessibility usually refers to the physical distance of health facility or the
travel time required for people to get the needed or desired health services.
Affordability is not only in consideration of the individual or family’s
capacity to pay for basic health services. Particularly for public health
services, it is also matter of whether the community or government can
afford these services.
Acceptability means that the health care offered is in accordance with the
prevailing culture and traditions of the population.
Availability is a question of whether the basic health services required by
the people are offered in the health care facilities or is provided on the
regular and organized manner
Support Mechanism
The resources for essential health services come from three (3) major
entities: the people, government, and private sectors. health programs and
projects provide better outputs when these three entities are involved.
Multisectoral approach - As health and disease are outcomes of multiple
interrelated factors, PHC requires communication, cooperation, and
collaboration within and among various sectors. This is exemplified
through intrasectoral and intersectoral linkages
Community participation A key to understanding the concept of PHC put
emphasis on how it is defined: that health is achieved through self-reliance
and self-determination, and that individuals, families, and communities are
not considered as recipients of care but active participants in achieving their
health goals
Equitable distribution of health resources - ‘universal access to health
services irrespective of the ability to pay’ Lack of equitable distribution
means that some people do not even get a decent basic minimum of care
while some populations have a concentrated health services
Appropriate technology - Technology is “applied science”. Health
technology includes tools, drugs, methods, procedures, and techniques.
Appropriate technology refers to the technology that is suitable to the
community that will use it
TRADITIONAL AND ALTERNATIVE HEALTH CARE
- R.A. 8423 or the Traditional and Alternative Medicine Act of 1997
- Philippine Institute of Traditional and Alternative Health Care Tasked to
promote and advocate the use of traditional and alternative health care
modalities through scientific research and product development.
ALTERNATIVE HEALTH CARE MODALITIES PRACTICED
ACUPRESSURE A method of healing and health promotion that uses the
application of pressure on acupuncture points without puncturing the skin.
ACUPUNCTURE A method of healing using special needles to puncture
and stimulate specific anatomical points on the body.
AROMATHERAPY The art and science of the sense of smell whereby
essential aromatic oils are combined and then applied to the body in some
form of treatment
CHIROPRACTIC A discipline of the healing arts concerned with the
pathogenesis, diagnosis, therapy, and prophylaxis of functional
disturbances, pathomechanical states, pain syndromes, and
neurophysiological effects related to the static and dynamics of the
locomotor system, especially of the spine and pelvis.
HERBAL MEDICINE/ PHYTOMEDICINE Finished, labeled,
medicinal products that contain as active ingredients aerial or underground
parts of the plant or other materials or combination
MASSAGE superficial soft parts of the body are rubbed, stroked, kneaded,
or tapped for remedial, aesthetic, hygienic, or limited therapeutic purposes.
NUTRITIONAL THERAPY It is synonymous with nutritional healing.
PRANIC HEALING A holistic approach of healing that follows the
principle of balancing energy.
REFLEXOLOGY The application of therapeutic pressure on the body's
reflex points to enhance the body's natural healing mechanisms and balance
body functions.