FAMILY ▪
TYPES OF FAMILY
What is Family?
• basic unit and one of the most important institutions in a
society
• a group of individuals related by blood, marriage, or adoption
• an open and developing system of interacting personalities
with structure and process enacted in relationships among
individual members regulated by resources within the larger
community
• a set of parents living with their children
• help us get through the most disastrous times and the best
times
FAMILY AS A SYSTEM
- made up of interrelated elements or objectives, they exhibit
coherent behaviors, they have regular interactions, and
they are interdependent on one another.
FAMILY AS A CLIENT
- Develop its own patterns of behavior and its own style in
life.
- Develops their own power system which either be: Balance-
the parents and children have their own areas of decisions
and control. Strongly Bias-one member gains dominance
over the others.
Nuclear Family
- structure is what many people immediately think of when
asked to imagine a family.
- a biological mother and father living together and raising
their children together.
- include adopted and/or foster children while still fitting
into the same structure.
▪ Same-Sex Family
- A counterpoint to the nuclear family structure that has
become more common in recent years is the same-sex
family structure, in which children are raised by two
mothers or two fathers.
▪ Single-Parent Family
- In a single-parent family, there is only one adult who is
raising children. The other parent might not be there for
many different reasons – death, divorce, etc. About 25% of
American children are born to single mothers.
▪ Blended Family (Step Families)
- A blended family forms when one single parent marries
another single parent.
▪ Grandparent Family
- Sometimes, for various reasons, a child is raised by his
grandparents instead of his parents. When grandparents
are raising their grandchildren without help from the
children’s parents, this is a grandparent family.
▪ Childless Family/DYAD
- Not all families have children. Some couples choose not to
have children, and some couples are not able to have
children, but they are still a family.
▪ Extended Family
- An extended family might include one or two parents,
children, grandparents, aunts and uncles, and/or cousins all
living together. As grandparents get older, they might move
in with their adult children and grandchildren. Or if a
spouse (husband or wife) dies, another adult family member
might move in to help with the children. There are many
reasons why a family might live together in this way.

▪ Cohabiting Family/Live-In Families

- unmarried couple living together

▪ Foster Family
- substitute family for children whose parents are unable to
care for them

▪ Communal Family
- more than one monogamous couple sharing resources

FAMILY HEALTH
NURSING PROCESS
What is Nursing Process?
• The Nursing Process (NP) is defined as a systematic,
continuous, and dynamic method of providing care to clients. It
comprises a series of sequential phases built upon the
preceding steps.
Significance
• The nursing process, which is the most important tool for
putting nursing knowledge into practice, is a systematic
problem-solving method for determining the health care needs
of a healthy or ill individual and for providing personalized
care.
History
• Lydia Hall (1955) introduced the term nursing process. Lydia
identified three aspects of nursing care: CARE, CURE, AND
CORE, and the three steps of the nursing process:
OBSERVATION, MINISTRATION OF CARE, and VALIDATION.
• In 1959, Dorothy Johnson described nursing as fostering the
behavioral functioning of the client. She further explained that
there are three steps in the nursing process: ASSESSMENT,
DECISION, and NURSING ACTION.
In 1961, Ida Lois Orlando explained a three-step nursing
•
process: CLIENT’S BEHAVIOUR, NURSE’S REACTION, AND
NURSE’S ACTIONS. In 1963, Lois Knowles gave a five-step
nursing process using the ‘five Ds’: DISCOVER, DELVE, DECIDE,
DO and DISCRIMINATE. The discovery and delve steps are
related to the assessment phase, decide is the planning stage, do
is the implementation stage; discriminate is the evaluation
phase of client responses to nursing interventions.
STEPS
• Assessment
- It involves collecting, organizing, validating, and
documenting the clients’ health status. This data can be
obtained in a variety of ways. Usually, when the nurse first
encounters a patient, the nurse is expected to assess to
identify the patient’s health problems as well as the
physiological, psychological, and emotional state and to
establish a database about the client’s response to health
concerns or illness and the ability to manage health care
needs.
• Diagnosis
- The nurse will analyze all the gathered information and
diagnose the client’s condition and needs. Diagnosing
involves analyzing data, identifying health problems, risks,
and strengths, and formulating diagnostic statements
about a patient’s potential or actual health problem.
• Planning
- The planning phase is where goals and outcomes are
formulated that directly impact patient care based on
evidence-based practice (EBP) guidelines. These patient-
specific goals and the attainment of such assist in ensuring
a positive outcome.

• Implementation
- It involves action or doing and the actual carrying out of
nursing interventions outlined in the plan of care.
• Evaluation
- Once all nursing intervention actions have taken place, the
team now learns what works and what doesn’t by
evaluating what was done beforehand. Whenever a
healthcare provider intervenes or implements care, they
must reassess or evaluate to ensure the desired outcome has
been met.
DEFINITION OF TERMS
• Family
- The family is a group of persons united by ties of marriage,
blood or adoption, constituting a single household,
interacting and communication with each other in their
respective social roles.
• Family Health
- Is a dynamic, changing, relative side of well-being which
includes the biological, psychological, spiritual,
sociological, and cultural factors of the family system.
• Family Health Nursing
- is the practice of nursing directed toward maximizing the
health and well-being of all individuals within a family
system
- Family health nursing is generally well-rounded,
integrated, ongoing, and requires extensive planning to
achieve its objectives.
- The goal: optimal functioning for the individual and for the
family as a unit.
HISTORY OF FAMILY HEALTH NURSING
▪ Nightingale Era
- Florence Nightingale - establishment of district nursing of
the sick and poor and the work of health missionaries’
through health-at-home teaching
▪ In Early 1900’s and 1960’s
- Women continued the centuries-old traditions (usually,
women’s role was largely limited to the home or domestic
work, and you know the rest)
▪ 1930
- Nurses are assigned to families
- Psychiatry and mental health disciplines-family therapy
focus
▪ 1960
- Concepts of maternal, child, and family care incorporated
into basic curriculums of nursing schools.
- Family studies and research produce family theories.
- Shift from public health to community health nursing
occurs
▪ 1970
- Development of nursing models that consider family as a
unit of analysis
- Many specialties focus on the family.
- Masters and doctoral programs focus on family
▪ 1980
- White House Conference on Families
- Greater emphasis is put on health from very young to old
- Family nursing research increases
▪ 1991
- Family leave legislation is passed
▪ 1995
- Journal of Family Nursing Research is born
 FAMILY HEALTH NURSING PROCESS Diagnosis Phase
- The nurse identifies both actual and potential client problems.
• It is a systematic approach to help family to develop and
strengthen it’s capacity to meet it’s health needs and solve
health problems. Examples of common nursing diagnoses for home care include:
• The family nursing process is the application of the generic • Deficient Knowledge,
nursing process grounded in knowledge of family nursing and • Impaired Home Maintenance
family history • Risks for caregiver Role strain.

ELEMENTS OF NURSING PROCESS Planning Phase

a. Assessment of client’s problem - It is based on the diagnosis

b. Diagnosis of client response needs that nurse can deal with - The nurse needs to encourage and permit clients to make their
c. Planning of client’s care own health management decisions.
d. Implementation of care
e. Evaluation of the success of implemented care STEPS:
1. Analysis of diagnosed health problems and assessment of
Assessment Phase families' ability to resolve problems (second assessment)
2. Criteria for setting priorities
- The standards of determining family health status can be -the
3. Setting goals and objectives
optimum health of individual members -family lifestyle -family
4. Family health nursing care plan
environment -family structure, and characteristics that
compare families' health with these standards.

STEPS OF THE ASSESSMENT PHASE Action Phase

1. plan for data collection
2. data collection methods and techniques
3. analysis of data It should be categorized as health deficit, health
threats, and foreseeable crisis situations
- The implementation phase of the nursing process is when the
nurse puts the treatment plan into effect.
STEPS:
1. review of the plan and mobilization of resources
2. implementation and documentation CHN required to
3. give adequate information
 4. help the family to understand the situation
5. relate families exiting socio-economic conditions to health
problems
6. motivate the family to implement actions
7. utilize the equipment and supplies
8. help the family to utilize the community resources
Evaluation Phase
- The evaluation is based on the set objectives to involve the
family In setting the objectives to bring the desired changes in
attitude.
- The nurse should observe for change in attitude during and
after the intervention of care. If she notices the failure brings to
the desired change, then she needs to go back to reset the
objective, replant and re-implement the programming.
QUANTITATIVE EVALUATION
- It determines the extent of services rendered to the family. It
accounts for the number of visits, clinic visits, no. of
immunization completed, reduction in mortality and morbidity
QUALITATIVE EVALUATION
- Structure evaluation - it measures the adequacy of resources in
terms of manpower, material, time, etc.
- Process evaluation -it measures the adequacy of nurses' actions
and activities in implementing the nursing process
- Outcome evaluation - it measures the end result of the care
given to the client
NURSING HOME VISIT
- A nursing home visit is a family-nurse contact which allows the
health worker to assess the home and family situations in order
to provide the necessary nursing care and health related
activities.
PURPOSES:
1. To give care to the sick, to a postpartum mother and her
newborn with the view teach a responsible family member to
give the subsequent care.
2. To assess the living condition of the patient and his family and
their health practices in order to provide the appropriate health
teaching.
3. To give health teachings regarding the prevention and control
of diseases.
4. To establish close relationship between the health agencies and
the public for the promotion of health.
5. To make use of the inter-referral system and to promote the
utilization of community services
 2. Healthy maintenance/health
TYPOLOGY OF NURSING management
3. Parenting
PROBLEMS IN FAMILY 4. Breastfeeding
5. Spiritual well-being-process of client’s

NURSING PRACTICE developing/unfolding

through
of mystery
harmonious
interconnectedness that comes from
inner strength/sacred source/God
Definitions (NANDA 2001)
6. Others. Specify.
• Typology
B. Readiness for Enhanced Capability for:
➢ is a system used for putting things into groups
1. Healthy lifestyle
according to how they are similar: the study of how
2. Health maintenance/health
things can be divided into different types.
management
➢ A typology, or categorization of interventions, based
3. Parenting
on the level of intended change can help to explain
4. Breastfeeding
and guide nursing therapeutics, that is, the various
5. Spiritual well-being
interventions selected for a specific patient. Clinical
6. Others. Specify.
judgment encompasses diagnostic, ethical, and
therapeutic judgment. II. Presence of Health Threats
• Typology of Nursing Therapeutics A. Presence of risk factors of specific diseases (e.g. lifestyle
➢ is proposed in relation to the intended level of alteration diseases, metabolic syndrome)
of patient responses, patterns, or life processes. Nursing B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately
therapeutics is described as single or multiple
provide
interventions by the nurse to alter life processes, life D. Accident hazards specify.
patterns, and functional health patterns. 1. Broken chairs
2. Pointed /sharp objects, poisons and
medicines improperly kept
1ST LEVEL ASSESSMENT 3. Fire hazards
4. Fall hazards
I. Presence of Wellness Condition
A. Potential for Enhanced Capability for: 5. Others specify
1. Healthy lifestyle-e.g. nutrition/diet, E. Faulty/unhealthful nutritional/eating habits or feeding
techniques/practices. Specify
exercise/activity
 1. Inadequate food intake both in quality
and quantity
2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors. Specify
1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family
members
4. Caregiving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.
1. Inadequate living space
2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sites of
vectors of diseases
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices.
Specify.
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate
footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of /inadequate exercise/physical
activity
11. Lack of/relaxation activities
12. Non use of self-protection measures (e.g.
non use of bed nets in malaria and
filariasis endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse
control
K. Health History, which may Participate/Induce the
Occurrence of Health Deficit, e.g. previous history of
difficult labor.
L. Inappropriate Role Assumption- e.g. child assuming
mother’s role, father not assuming his role.
M. Lack of Immunization/Inadequate Immunization Status
Specially of Children
N. Family Disunity-e.g.
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
4. O. Others
III. Presence of Health Deficits
A. Illness states, regardless of whether it is diagnosed or
undiagnosed by medical practitioner.
B. Failure to thrive/develop according to normal rate
C. Disability-whether congenital or arising from illness;
transient/temporary (e.g. aphasia or temporary paralysis
after a CVA) or permanent (e.g. leg amputation secondary to
diabetes, blindness from measles, lameness from polio)
IV. Presence of Stress Points & Foreseeable Crisis
Situations
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
 E. Abortion D. Lack of/inadequate knowledge/insight as to alternative
F. Entrance at school courses of action open to them
G. Adolescence E. Inability to decide which action to take from among a list
H. Divorce or separation of alternatives
I. Menopause F. Conflicting opinions among family members/significant
J. Loss of job others regarding action to take.
K. Hospitalization of a family member G. Lack of/inadequate knowledge of community resources
L. Death of a member for care
M. Resettlement in a new community H. Fear of consequences of action, specifically:
N. Illegitimacy 1. Social consequences
O. Others 2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
2nd LEVEL ASSESSMENT I. Negative attitude towards the health condition or
problem-by negative attitude is meant one that interferes
I. Inability to Recognize the Presence of the Condition or
with rational decision-making.
Problem due to:
J. In accessibility of appropriate resources for care,
A. Lack of or inadequate knowledge
specifically:
B. Denial about its existence or severity as a result of fear of
1. Physical Inaccessibility
consequences of diagnosis of problem, specifically:
1. Social-stigma, loss of respect of 2. Costs constraints or economic/financial
peer/significant others inaccessibility
2. Economic/cost implications K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed
3. Physical consequences course(s) of action
4. Emotional/psychological M. Others
issues/concerns
C. Attitude/Philosophy in life, which hinders III. Inability to Provide Adequate Nursing Care to the Sick,
recognition/acceptance of a problem Disabled, Dependent or Vulnerable/ at Risk Member of
D. Others. the Family due to:
A. Lack of/inadequate knowledge about the disease/health
II. Inability to Make Decisions with Respect to Taking condition (nature, severity, complications, prognosis and
Appropriate Health Action due to: management)
A. Failure to comprehend the nature/magnitude of the B. Lack of/inadequate knowledge about child development
problem/condition and care
B. Low salience of the problem/condition C. Lack of/inadequate knowledge of the nature or extent of
C. Feeling of confusion, helplessness and/or resignation nursing care needed
brought about by perceive magnitude/severity of the D. Lack of the necessary facilities, equipment and supplies of
situation or problem, i.e. failure to breakdown problems care
into manageable units of attack. E. Lack of/inadequate knowledge or skill in carrying out the
necessary intervention or treatment/procedure of care (i.e.
 complex therapeutic regimen or healthy lifestyle G. Lack of supportive relationship among family members
program). H. Negative attitudes/philosophy in life which is not
F. Inadequate family resources of care specifically: conducive to health maintenance and personal
1. Absence of responsible member development
2. Financial constraints I. Lack of/inadequate competencies in relating to each other
for mutual growth and maturation (e.g. reduced ability to
3. Limitation of luck/lack of physical meet the physical and psychological needs of other
resources members as a result of family’s preoccupation with
G. Significant person's unexpressed feelings (e.g. current problem or condition.
hostility/anger, guilt, fear/anxiety, despair, rejection) J. Others
which his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, V. Failure to Utilize Community Resources for Health Care
disabled, dependent, vulnerable/at risk member due to:
I. Member’s preoccupation with on concerns/interests A. Lack of/inadequate knowledge of community resources
J. Prolonged disease or disabilities, which exhaust for health care
supportive capacity of family members. B. Failure to perceive the benefits of health care/services
1. Role denials or ambivalence C. Lack of trust/confidence in the agency/personnel
2. Role strain D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic,
3. Role dissatisfaction therapeutic, rehabilitative) specifically :
4. Role conflict 1. Physical/psychological consequences
5. Role confusion 2. Financial consequences
6. Role overload 3. Social consequences
7. Others F. Unavailability of required care/services
G. Inaccessibility of required services due to:
IV. Inability to Provide a Home Environment Conducive to 1. Cost constrains
Health Maintenance and Personal Development due to: 2. Physical inaccessibility
A. Inadequate family resources specifically: H. Lack of or inadequate family resources, specifically
1. Financial constraints/limited financial 1. Manpower resources, e.g. baby sitter
resources 2. Financial resources, cost of medicines
2. Limited physical resources-e.i. lack of prescribe
space to construct facility I. Feeling of alienation to/lack of support from the
B. Failure to see benefits (specifically long term ones) of community, e.g. stigma due to mental illness, AIDS, etc.
investments in home environment improvement J. Negative attitude/ philosophy in life which hinders
C. Lack of/inadequate knowledge of importance of hygiene effective/maximum utilization of community resources for
and sanitation health care
D. Lack of/inadequate knowledge of preventive measures K. Others
E. Lack of skill in carrying out measures to improve home
environment
F. Ineffective communication pattern within the family
 Weight : 1

SCALING FOR RANKING HEALTH Scale:

CONDITIONS AND PROBLEMS ACCORING High 3
TO PRIORITIES Moderate 2
• Nature of the Problem Presented Low 1
o Categorized whether a Health Threat, Health Deficit or
Foreseeable Crisis. • Salience
Weight: 1 o Refers to the family perception & evaluation of the
problem in terms seriousness & urgency of attention
Scale: needed.
Wellness State 3 Weight: 1
Health Threat 3
Scale:
Health Deficit 2
Forseable Crisis 1 A serious problem, 2
immediate attention
A problem but not needing 1
• Modifiability of the Problem
o Refers to the probability of success in minimizing immediate attention
alleviating or totally eradicating the problem through Not a felt need/problem 0
health intervention.

Weight: 2 SCORING
Scale: 1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and multiply
Easily Modifiable 2 by the weight
Partially Modifiable 1 3. Sum up the scores for all the criteria. The highest score is
5, equivalent to the total weight.
Not Modifiable 0 ➢ The higher the score (near 5 and above) of a given
problem, the more likely it is taken as a PRIORITY.
• Preventive Potential ➢ With the available scores, the nurse then RANKS health
o Refers to the nature and magnitude of the future problems accordingly.
problem that can be minimized or totally prevented if
intervention is done in the problem.
 The UN aims that by 2015,
MILLENNIUM
DEVELOPMENT GOALS
(MDG)
What is MDG?
• MDG stands for Millennium Development Goals.
• A set of time-bound and measurable goals and targets for
combating poverty, hunger, diseases, illiteracy, environmental
degradation and discrimination against women.
• It consists of 8 goals, 18 targets and 48 indicators, covering the
period 1990 to 2015
When and How did MDG start?
• In September 2000, member states of the United Nations (UN)
gathered at the Millennium Summit to affirm commitments
towards reducing poverty and the worst forms of human
deprivation. The Summit adopted the UN Millennium
Declaration which embodies specific targets and milestones in
eliminating extreme poverty worldwide. A total of 189
What efforts has the Philippines done to support the MDG’s?
countries, including the Philippines committed themselves to
making the right to development a reality for everyone.
• the proportion of people suffering from extreme poverty and
•
hunger will be halved;
all children will be in primary school;
• girls will have the same educational opportunities as boys;
• the proportion of people without access to safe drinking water
will be halved;
• the spread of HIV/AIDS and malaria will be stopped;
• a child’s risk of dying before the age of five will be reduced by
two-thirds;
• a mother’s risk of dying while pregnant will be reduced by
three quarters;
• the world’s ecosystem and biodiversity will be better protected
from destruction;
• at least 100 million slum dwellers will get better housing,
health care, and new opportunities for education;
• people in developing countries will have greater access to
essential drugs;
• the benefits of new technologies, especially information
technologies, will flow to more countries and more people;
and
• wealthy countries will support developing countries with debt
relief, more financial aid, and greater market access.
• Philippines came up with the first Philippines Progress Report
on the Millennium Development goals.
MILLENNIUM DEVELOPMENT GOALS
1. Eradicate Extreme Poverty and Hunger
2. Achieve Universal Primary Education
3. Promote Gender Equality and Empower Women
4. Reduce Child Mortality
5. Improve Maternal Health
6. Combat HIV/AIDS, Malaria and other diseases
7. Ensure Environmental Sustainability
8. A Global Partnership for Development
 SUSTAINABLE SDG 17 GOALS TO TRANSFORM OUR
WORLD
DEVELOPMENT GOALS 1.
2.
No Poverty
Zero Hunger
3. Good Health and Well-Being
4. Quality Education
5. Gender Equality
What is Sustainable Development Goals? 6. Clean Water and Sanitation
7. Affordable and Clean Energy
- Aims to transform our world. They are a call to action to end 8. Decent Work and Economic Growth
poverty and inequality, protect the planet, and ensure that all 9. Industry, Innovation and Infrastructure
people enjoy health, justice and prosperity. It is critical that no 10. Reduced Inequalities
11. Sustainable Cities and Communities
one is left behind.
12. Responsible Consumption and Production
- Also, known as the Global Goals, were adopted by the United 13. Climate Action
Nations in 2015 as a universal call to action to end, to end 14. Life Below Water
poverty, to protect the planet, to ensure that by 2030 all people 15. Life On Land
16. Peace, Justice and Strong Institutions
enjoy peace & prosperity. 17. Partnerships for the Goals

What is the importance of Sustainable Development Goals?

- The SDGs provide worldwide guidance for addressing the

global challenges facing the international community. It is
about better protecting the natural foundations of life and our
planet everywhere and for everyone, and preserving people's
opportunities to live in dignity and prosperity across
generations.

DEPARTMENT OF
HEALTH (HISTORICAL
BACKGROUND)
▪ Pre-Spanish and Spanish Periods (before 1898)
- traditional healthcare practices especially the use of herbs
and rituals for healing were widely practiced during these
periods.
- The country's western concept of public health services is
traced to the first dispensary for indigent patients of Manila
by a Franciscan friar that was begun in 1577.
- In 1876, Medicos Titulares, equivalent to provincial health
officers, already existed.
- In 1888, the Spaniards created a Superior Board of Health
and Charity, which established a hospital system and a
board of vaccination.
▪ June 23, 1898
- After the proclamation of the Philippine independence
from Spain, the Department of Public Works, education,
and Hygiene was created by virtue of a decree signed by
President Emilio Aguinaldo.
▪ September 29, 1898
- General Order No. 15 established the Board of Health for the
City of Manila with the primary objective of protecting the
health of American soldiers.
▪ July 1, 1901
a Board of Health for the Philippine Islands was created
-
through Act No. 157 because it was realized that it was
impossible to protect the American soldiers without
protecting the natives.
- Act Nos. 307, 308 dated December 2, 1901, established the
Provincial Municipal Boards respectively to complete the
health organization in accordance with the territorial
division of the islands.
▪ October 26, 1905
- The Insular Board of Health proved to be inefficient
operationally so it was abolished and was replaced by the
Bureau of Health under the Department of Interior through
Act No. 1487 in 1906 and replaced the provincial boards of
health with district health officers.
▪ 1912
- Act No. 2156 also known as the Fajardo Act, consolidated
the municipalities into sanity divisions and established
what is known as the Health Fund for travel and salaries.
▪ 1915
- Act No. 2468 transformed the Bureau of Health into a
commissioned service called the Philippine Health Service.
- This introduced a systematic organization of personnel
with corresponding civil service grades and a secure system
of civil service entrance and promotion described as the
“semi-military system of public health administration”.
▪ August 2, 1916
- The passage of the Jones Law also known as the Philippine
Autonomy Act provided the highlight the struggle of the
Filipinos for independence from American rule.
- The establishment of an elective Philippine Senate
completed an all-Filipino Philippine Assembly that formed
a bicameral system of government. This ushered in a major
 reorganization which culminated in the Administrative
Code of 1917 (Act 2711), which included the Public Health
Law of 1917.
▪ 1932
- Act No. 4007 known as the Reorganization Act of 1932,
reverted back the Philippine Service into the Bureau of
Health and combined the Bureau of Public Welfare under
the Office of the Commissioner of Health and Public
Welfare. The Philippine Commonwealth and the Japanese
Occupation (1935 -1945).
▪ May 31, 1939
- Commonwealth Act No. 430 created the Department of
Public Health and Welfare, but the full implementation was
only completed through Executive Order No. 317.
▪ January 7, 1941
- Dr. Jose Fabella became the first Department Secretary of
Health and Public Welfare in 1941.
▪ October 4, 1947
- Executive Order No. 94 provided the post-war
reorganization of the Department of Health and Public
Welfare.
- This resulted in the split of the Department with the transfer
of the Bureau of Public Welfare and the Philippine General
Hospital to the Office of the President.
- Another split was created between the curative and
preventive services through the creation of the Bureau of
Hospitals which took over the curative services. Preventive
care services remained under the Bureau of Health.
- This order also established the Nursing Service Division
under the Office of the Secretary.
▪ January 1, 1951
- The Office of the President of the Sanitary District has
converted into a Rural Health Unit, carrying out 7 basic
health services: maternal and child health, environmental
health, communicable disease control, vital statistics,
medical care, health education, and public health nursing.
- The Rural Health Act of 1954 (RA 1082) created more rural
health units and created posts for municipal health officers,
among other provisions.
▪ February 20, 1958
- Executive Order No. 288 provided for what is described as
the “most sweeping” reorganization in the history of the
Department.
- An office of the Regional Health Director was created in 8
regions and all health services were decentralized to the
regional, and provincial making and development of
procedures. RHUs we’re made an integral part of the public
healthcare delivery system.
▪ 1970
- The Restructures Health Care Delivery System was
conceptualized; under this concept, the public health nurse-
to-population ratio was 1:20,000.
▪ June 2, 1978
- with the proclamation of martial law in the country,
Presidential Decree 1397 renamed the Department of
Health to the Ministry of Health. Secretary Gatmaitan
became the first Minister of Health.
▪ December 2, 1982
- Executive Order No. 851 signed by President Ferdinand E.
Marcos reorganized the Ministry of Health as an integrated
healthcare delivery system.
▪ April 3, 1987
 - Executive Order No. 119, “Reorganizing the Ministry of
Health by President Corazon c. Aquino saw a major change
in the structure of the ministry. It transformed the Ministry
of Health back into the Department of Health.
- EO 119 clustered agencies and programs under the Office
for Standards and regulations and Office of Management
Services.
▪ October 10, 1991
- Republic Act 7160 known as the Local Government Code
provided for the decentralization of the entire government.
- Under this law, all structures, personnel, and budgetary
allocations from the provincial health level down to the
barangays were devolved to the local government units
(LGUs) to facilitate health service delivery.
▪ May 24, 1999
- Executive Order No. 102 “Redirecting the Functions and
Operations of the Department of Health” by President
Joseph E. Estrada granted the DOH to proceed with its
rationalization and Streamlining Plan which prescribed the
current organizational, staffing and resource structure
consistent with its new mandate, roles and functions post
devolution.
- Mandates the department of Health to provide assistance to
LGUs, people’s organization, and other members of civic
society in effectively implementing programs, projects and
services that will promote the health and well-being of
every Filipino; prevent and control diseases among
population at risks; protect individuals, families and
communities exposed to hazards and risks that could affect
their health; and treat, manage and rehabilitate individuals
affected by diseased and disability.2005 ongoing
Development of a plan to rationalize the bureaucracy in an
attempt to scale down including the DOH.
LOCAL HEALTH SYSTEM & DEVOLUTION
OF HEALTH SERVICES
Historical Background:
• 1991 - the page of Local Government Code (Republic Act 7160)
Objectives:
1. Establish local delivery of health care services.
2. Upgrade the healthcare management and service capabilities of
local health facilities.
3. Promote inter- LGU linkages and cost-sharing schemes
including local healthcare financing systems for better
utilization of local health resources.
4. Foster participation of the private sector, non-government
organizations (NGOs), and communities in local health systems
development.
5. Ensure the quality of health service delivery at the local level.
Inter Local Health System
• a system of health care similar to a district health system in
which individuals, communities, and all other healthcare
providers in a well-defined geographical area participate
together in providing quality equitable, and accessible
healthcare with Inter Local Government Unit (ILGU)
partnership as the basic framework.
 • Education for Health
- a potent methodology for information dissemination
The Basic Framework of LHS
- promotes a partnership of both the family members and
• The basic framework of local health systems is inter -LGU health workers
partnership. • Locally Endemic Disease Control
- focuses on the prevention of disease occurrence to reduce
the morbidity rate
Inter-Local Health Zone • Environmental Sanitation and Promotion of Safe Water
Supply
• Any form of organized arrangement for coordinating the
- Clean Water Act of 2004
operations of an array and hierarchy of health providers and
- Clean Air Act
facilities serving a common population within a local
- Sanitation Code (PD 856)
geographic area under the jurisdictions of more than one local
- Proper Excreta and Sewage Disposal
government (DOH, CY 2006)
- Program
• Nutrition and Promotion of Adequate Food Supply
- Food Sanitation Program
FOUR PILLARS OF PHC • Treatment of Communicable Diseases and Common
Illness
• Appropriate Technology • Supply of Essential Drugs
• Support Mechanism
• Active Community Participation
• Intra- and Inter- Sectoral Lingkage
TYPES OF PHC WORKERS
• PHC Workers are categorized depending upon:
ELEMENTS OF PHC o Availability of health manpower resources
o Identified local health needs and problems
• Expanded Program on Immunization
o Political and financial feasibility
- PD 996
• Maternal and Child Health with Family Planning
- Check-up for mothers
- EO 51 2 LEVELS OF PHC WORKERS
- Rooming-In and BF Act of 1992 1. Village or Barangay Health Workers
- Food Fortification Law (RA 8976)
- NBS
 - refers to trained community health workers or health PHILIPPINES HEALTHCARE AGENDA
auxiliary volunteers or traditional birth attendants or
GOALS:
healers.
2. Intermediate Level Health Workers The Health System We Aspire For:
- general medical practitioners or their assistants, PHN, rural • RESPONSIVENESS
sanitary inspectors, and midwives - Filipino feel respected, valued and empowered in all of their
interaction with health system. Access to health
interventions through functional Service Delivery
LEVELS OF HEALTH CARE AND REFERRAL Networks.
SYSTEM • FINANCIAL PROTECTION
- Filipinos, especially the poor, marginalized and vulnerable
1. Primary Level of Care
are protected from high cost health care.
2. Secondary Level of Care
3. Tertiary Level of Care • BETTER HEALTH OUTCOMES
- Filipinos attain the best possible health outcomes with no
disparity.

PHC TEAM
• Physician VALUES:
• Nurses
The Health System We Aspire For:
• Midwives
• Nurse Auxiliaries • Equitable & Inclusive to All
• Locally Trained CHWs • Transparent & Accountable
• Traditional Birth Attendants
• Uses Resources Efficiently
• Provides High Quality Services

RURAL HEALTH UNIT

• Physician Persistent Inequalities in Health Outcomes
• Dentist • Every year, around 2000 mothers die due to pregnancy-related
• PHN
complications.
• Midwife
• Sanitarian • A Filipino child born to the poorest family is 3 times more likely
• Other Health Workers to not reach his 5th birthday, compared to one born to the
richest family.
 • Three out of 10 children are stunted

Restrictive and Impoverishing Healthcare Costs

• Every year, 1.5 million families are pushed into poverty due to
healthcare expenditures
• Filipinos forego or delay care due to prohibitive and
unpredictable user fees or co-payments
• Php 4,000/month healthcare expenses are considered
catastrophic for single-income families

Poor Quality and Undignified Care Synonymous with Public

Clinics and Hospitals

• Long wait times

• Limited autonomy to choose a provider
• Less than hygienic restrooms, lacking amenities
• Privacy and confidentiality are taken Lightly
• Poor record-keeping
• Overcrowding & under-provision of care