Primary Health Care Day 1 - The rendering of health care services to the people is called

health care delivery system.

- The health care delivery system is the network of health facilities
and personnel which carries out the task of rendering health care
to the people.

Levels of Health Facilities

 Primary
- BHS,
- MHC/RHU = clinics, Emergency hospitals,
- B(Basic)EMONC= Lying-in
- Suction machine, Oxygen

 Secondary
- District hospitals ( Inter- Local Health Zone),
 LEVELS OF PREVENTION
- Provincial hospitals,
- C(comprehensive)EMONC
 Primary
- C/S. BT
- healthy
- promotion of health
 Tertiary
- achieve the highest level of wellness
- Regional Hospitals
Nutrition, exercise
- PGH, specialized hospitals
Prevention of illness- Identify the different risk factors
Specific disease
Levels of Health Care Workers
Immunization
- Primary= MWs
 Secondary
- Secondary= Nurses
- sick
- tertiary= Doctor
- restore health, cure,
o X-ray Technician, Medical Technologists= back ups in the
Early detection = early treatment; limit the disease process,
diagnosis
to shorten illness, to prevent complication

- Health Team
 Tertiary
- RHP 1:20000
- Recovered
- PHN RHD, RSI, BNS1: 20000
- Remnant of diseases ( optimum level of functioning
- RHM- first health professional 1Mw: 5000 pop
- BHW--- 1:20 households
HEALTH CARE DELIVERY SYSTEM
- Health care system is an organized plan of health services.
  Local Health Board
=Municipal Level
● Mayor---- chairman
● Rural Health Physician----C0-chairman

= Provincial Level
● Governor---- chairman
● Provincial Health Officer

DOH
- Regional, PGH, Specialized
- Basically, the DOH has three major roles in the health sector:
- (1) leadership in health;
- (2) enabler and capacity builder; and
- (3) Administrator of specific services.
- Leading causes of Morbidity ( sickness), Mortality (deaths)
Mortality (deaths)
- Heart
- Ds of the vascular system
- Cancer
- Pneumonia
Restructured Health care Delivery System - Accidents
- TB
2- way Referral system After pandemic 2021
- Dm
- Hpn ds
Inter Local Health Zone - Pneumonia
- Covid
Devolution - Heart
 Its mandate is to develop national plans, technical standards, and
guidelines on health.
 Aside from being the regulator of all health services and products,
the
 DOH is the provider of special tertiary health care services and
technical assistance to health providers and stakeholders.
VISION
- “Filipinos are among the healthiest people in Southeast Asia
by 2022. Asia by 2040”
MISSION
- “To lead the country in the development of a Productive,
Resilient, Equitable and People Centered health system.”
GOALS
-“Better Health Outcomes, More Responsive Health System,
More Equitable Health Care Financing”
STRATEGIC PILLARS
- Financing, Service Delivery, Governance and Regulation
“PLUS”
- Performance Accountability
VALUES
- Integrity, Excellence and Compassion
NATIONAL OBJECTIVES ON HEALTH:
- Improve the general health status of the population
- Reduce morbidity and mortality from certain diseases
- Eliminate certain diseases as public health problems
- Promote healthy lifestyle and environmental health
- Protect vulnerable groups with special health and nutrition needs
- Strengthen national and local health systems to ensure better
health service delivery
- Pursue public health and hospital reform
- Reduce the cost and ensure the quality of essential drugs
Generic Law-
- Institute health regulatory reforms to ensure quality and safety
of health goods and services
- Strengthen health governance and management support
systems
- Institute safety nets for the vulnerable and marginalized groups
- Expand the coverage of social health insurance
- Mobilize more resources for health
- Improve efficiency in the allocation, production and utilization of
resources for health
All for health towards health for all. This is the vision of the
- Philippine Health Agenda 2016–2022.
UHC Law
- To ensure Filipinos has equitable access to quality Health
Services and avoid high out of the pocket health expenses.
Universal Health Coverage
- All Filipinos in automatically member of the National Health
Insurance Program.
Primary Health Care (PHC)
- is an essential health care made universally available to
individuals and families in the community by means acceptable
to them through their full participation and at a cost that the
community and country and can afford at every stage of
development.
 Definitions
World Health Organization (WHO)
- The WHO defines Primary Health Care an essential health care
made universally acceptable to individuals and families in the
community by means acceptable to them through their full
participation and at a cost that the community and country and
afford at every stage of development.
Alma Ata Declaration
- The Declaration of Alma-Ata was adopted at the International
Conference on Primary Health Care (PHC), Almaty (formerly
Alma-Ata), Kazakhstan (formerly Kazakh Soviet Socialist
Republic), 6-12 September 1978
- Eight essential elements based on the Alma Ata on PHC: An
essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally,
accessible to individuals and families in the community by means
of acceptable to them, through their full participation and at a
cost that community and country can afford to maintain at every
 stage of their development in the spirit of self-reliance and self- ● October 19, 1979. The President of the Philippines (Ferdinand
determination. Marcos) issued Letter of Instruction (LOI) 949 which mandated the
1. Health Education then Ministry of Health to adopt PHC as an approach towards design,
2. Treatment of Locally Endemic Diseases development, and implementation of programs which focus health
3. Expanded Program on Immunization development at the community level.
4. Maternal and Child Health
5. Provision of Essential Drugs  Rationale
6. Nutrition Adopting primary health care has the following rationales:
7. Treatment of communicable and non- ● Magnitude of Health Problems
communicable diseases ● Inadequate and unequal distribution of health resources
8. Safe water and good waste disposal ● Increasing cost of medical care
● Isolation of health care activities from other development
 Goals activities
- The ultimate goal of primary health care is better health for all.  Objectives
WHO has identified five key elements to achieving that goal: 1. Improvement in the level of health care of the community.
Health for all in the year 2000 and Health in the Hands in the year 2020 2. Favorable population growth structure
3. Reduction in the prevalence of preventable, communicable and
Self- Reliance other disease.
● Reducing exclusion and social disparities in health (universal 4. Reduction in morbidity and mortality rates especially among infants
coverage reforms); and children.
● Organizing health services around people’s needs and expectations 5. Extension of essential health services with priority given to the
(service delivery reforms); underserved sectors.
● Integrating health into all sectors (public policy reforms); 6. Improvement in basic sanitation.
● Pursuing collaborative models of policy dialogue (leadership 7. Development of the capability of the community aimed at self-
reforms); and reliance.
● Increasing stakeholder participation. 8. Maximizing the contribution of the other sectors for the social and
economic development of the community.
 History
A brief history of Primary Health Care is outlined below: Appropriate Technology
● May 1977. The 30th World Health Assembly adopted resolution
which decided that the main social target of governments and of
WHO should be the attainment by all the people of the world by the
year 2000 a level of health that will permit them to lead a socially and
economically productive life.
● September 6-12, 1978. International Conference in PHC was held in
this year at Alma Ata, USSR (Russia)
Acupressure/ Acupuncture

SANTA LUBBY

Infusion vs. Decoction


Elements
The following are the eight (8) essential elements of primary health care:
1. Education for Health
This is one of the potent methodologies for information dissemination. It
promotes the partnership of both the family members and health workers in
the promotion of health as well as prevention of illness.
2. Locally Endemic Disease Control
The control of endemic disease focuses on the prevention of its occurrence
to reduce morbidity rate. Example Malaria control and Schistosomiasis
control
3. Expanded Program on Immunization
This program exists to control the occurrence of preventable illnesses
especially of children below 6 years old. Immunizations on poliomyelitis,
measles, tetanus, diphtheria and other preventable disease are given for free
by the government and ongoing program of the DOH
4. Maternal and Child Health and Family Planning
The mother and child are the most delicate members of the community. So
the protection of the mother and child to illness and other risks would ensure
good health for the community. The goal of Family Planning includes spacing
of children and responsible parenthood.
5. Environmental Sanitation and Promotion of Safe Water Supply
Environmental Sanitation is defined as the study of all factors in the man’s
environment, which exercise or may exercise deleterious effect on his well-
being and survival. Water is a basic need for life and one factor in man’s
environment. Water is necessary for the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic promotion of health.
6. Nutrition and Promotion of Adequate Food Supply
One basic need of the family is food. And if food is properly prepared then
one may be assured healthy family. There are many food resources found in
the communities but because of faulty preparation and lack of knowledge
regarding proper food planning, Malnutrition is one of the problems that we
have in the country.
7. Treatment of Communicable Diseases and Common Illness
The diseases spread through direct contact pose a great risk to those who can
be infected. Tuberculosis is one of the communicable diseases continuously
occupies the top ten causes of death. Most communicable diseases are also
preventable. The Government focuses on the prevention, control and
treatment of these illnesses.
8. Supply of Essential Drugs
This focuses on the information campaign on the utilization and acquisition
of drugs. In response to this campaign, the GENERIC ACT of the Philippines is
enacted. It includes the following drugs: Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid) and
Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine
Principles
Primary health care is run with the following principles:
1. 4 A’s = Accessibility, Availability, Affordability and Acceptability,
Appropriateness of health services.
The health services should be present where the supposed recipients are.
They should make use of the available resources within the community,
wherein the focus would be more on health promotion and prevention of
illness.
2. Community Participation
Community participation is the heart and soul of primary health care.
3. People are the center, object and subject of development.
● Thus, the success of any undertaking that aims at serving the people
is dependent on people’s participation at all levels of decision-
making; planning, implementing, monitoring and evaluating. Any
undertaking must also be based on the people’s needs and problems
(PCF, 1990)
● Part of the people’s participation is the partnership between the
community and the agencies found in the community; social
mobilization and decentralization.
● In general, health work should start from where the people are and
building on what they have. Example: Scheduling of Barangay Health
Workers in the health center
Barriers of Community Involvement
● Lack of motivation
● Attitude
● Resistance to change
● Dependence on the part of community people
● Lack of managerial skills
4. Self-reliance
Through community participation and cohesiveness of people’s organization
they can generate support for health care through social mobilization,
networking and mobilization of local resources. Leadership and management
skills should be develop among these people. Existence of sustained health
care facilities managed by the people is some of the major indicators that the
community is leading to self-reliance.
5. Partnership between the community and the health agencies in the
provision of quality of life.
Providing linkages between the government and the non-
government organization and people’s organization.
6. Recognition of interrelationship between the health and development
● Health is defined as not merely the absence of disease. Neither is it
only a state of physical and mental well-being. Health being a social
phenomenon recognizes the interplay of political, socio-cultural and
economic factors as its determinant. Good Health therefore, is
manifested by the progressive improvements in the living conditions
and quality of life enjoyed by the community residents
● Development is the quest for an improved quality of life for all.
Development is multidimensional. It has political, social, cultural,
institutional and environmental dimensions (Gonzales 1994).
Therefore, it is measured by the ability of people to satisfy their basic
needs.
7. Social Mobilization
It enhances people’s participation or governance, support system provided
by the government, networking and developing secondary leaders.
8. Decentralization
This ensures empowerment and that empowerment can only be facilitated if
the administrative structure provides local level political structures with more
substantive responsibilities for development initiators. This also facilities
proper allocation of budgetary resources.
  Family – basic unit of Care •Healthy physically an d mentally

1. Community Health Care Process applied to the 5. High risk family – classification
- Family Health Care family • Young couple, many children
• Large family (5 children )
Assessment= • Low socio-economic status
• Living in congested housing
Initial Data Base • Low education
• Poor home sanitation
1. Health threats
2. Health deficit 6. Major functions of the family:
3. Foreseeable crises/ stress points • Physical
4. Wellness state • Economic
• Reproductive
2nd level assessment • Socialization

Planning 7. Family Structure

Priority Setting--- several Traditional
Criteria: Single parent
Nature Alternative Family Structure
Deficit/ well state-----3 Cohabiting – living together
Threat ------------------2 Homosexual / lesbian
Crisis---------------------1 MIDWIFE-PATIENT (Family) CONTACTS
Clinic Visits
Divide score with the highest score X weight Pre-consultation
3/3 X 1
Envelope (Family)---- Clinic records
Preventive potential, Home based records vs. Clinic based records
Modifiability of the problem and PINK CARD--- pregnant
Salience Yellow Card---- infants

Highest total 5 given the highest priority Advantages of HBR

Setting of goals and Objectives - Less loses
Program of Activities (Specific)
- Consultation done as soon as the family comes in
2. Health Problem – Health threat - Transfers to another locality no need referral record
3. Health Need – Health problem that family cannot cope
Consultation
4. Characteristics of Healthy Family Assessment, treatment,
• Aware and interested in life Post Consultation
• Energetic and active For follow up…. Evaluate the HE
• Pleasant disposition
• Guides family members
 HOME VISIT
A nursing home visit is a family-Midwife 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. In performing home
visits, it is essential to prepare a plan of visit to meet the needs of the client
and achieve the best results of desired outcomes.
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.
Postpartum
3rd day
1 week
6th week------ clinic visit
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.
Principles:
The following principles are involved when performing a home visit:
1. A home visit must have a purpose or objective.
2. Planning for a home visit should make use of all available
information about the patient and his family through family
records.
3. In planning for a home visit, we should consider and give priority
to the essential needs if the individual and his family.
4. Planning and delivery of care should involve the individual and
family.
5. The plan should be flexible.
Guidelines
The following guidelines are to be considered regarding the frequency of
home visits:
1. The physical needs, psychological needs and educational needs of the
individual and family.
2. The acceptance of the family for the services to be rendered, their
interest and the willingness to cooperate.
3. The policy of a specific agency and the emphasis given towards their
health programs.
4. Take into account other health agencies and the number of health
personnel already involved in the care of a specific family.
5. Careful evaluation of past services given to the family and how the
family avails of the nursing services.
6. The ability of the patient and his family to recognize their own needs,
their knowledge of available resources and their ability to make use
of their resources for their benefits.
Steps
1. Greet the patient and introduce yourself.
2. State the purpose of the visit
3. Observe the patient and determine the health needs.
4. Put the bag in a convenient place and then proceed to perform the
bag technique.
5. Perform the nursing care needed and give health teachings.
6. Record all important date, observation and care rendered.
7. Make appointment for a return visit.
Bag Technique
The public health bag is an essential and indispensable equipment of a public
health Midwife which she has to carry along during her home visits. It
contains basic medication and articles which are necessary for giving care.
Principles
● Performing the bag technique will minimize, if not, prevent the
spread of any infection.
● It saves time and effort in the performance of nursing procedures.
 ● The bag technique can be performed in a variety of ways depending *BP apparatus and stethoscope are carried separately and are never placed
on the agency’s policy, the home situation, or as long as principles of in the bag.
avoiding transfer of infection is always observed.
Points to consider
Contents 1. The bag should contain all the necessary articles, supplies and
The following are the contents of a Public Health Midwife bag: equipment that will be used to answer the emergency needs
● Paper lining 2. The bag and its contents should be cleaned very often, the
● Extra paper for making waste bag supplies replaced and ready for use anytime.
● Plastic/linen lining 3. The bag and its contents should be well protected from contact
● Apron with any article in the patient’s home.
● Hand towel 4. Consider the bag and its contents clean and sterile, while articles
● Soap in a soap dish that belong to the patients as dirty and contaminated.
● Thermometers (oral and rectal) 5. The arrangement of the contents of the bag should be the one
● 2 pairs of scissors (surgical and bandage) most convenient to the user, to facilitate efficiency and avoid
● 2 pairs of forceps (curved and straight) confusion.
● Disposable syringes with needles (g. 23 & 25) Steps
● Hypodermic needles (g. 19, 22, 23, 25) The following are steps in performing bag technique and rationale for each
● Sterile dressing action:
● Cotton balls Action Rationale
● Cord clamp Upon arrival at the patient’s home, To protect the bag from getting
● Micropore plaster place the bag on the table lined with contaminated.
● Tape measure a clean paper. The clean side must be
● 1 pair of sterile gloves out and the folder part, touching the
● Baby’s scale table
● Alcohol lamp
● 2 test tubes Ask for a basing of water or a glass of To be used for hand washing.
● Test tube holders drinking water if tap water is not
● Solutions of: available.
○ Betadine
Open the bag and take out the towel To prepare for hand washing.
○ 70% alcohol
and soap.
○ Zephiran solution
○ Hydrogen peroxide Wash hands using soap and water, To prevent infection from the care
○ Spirit of ammnonia wipe to dry. provider to the client.
○ Ophthalmic ointment
○ Acetic acid Take out the apron from the bag and To protect the nurse’s uniform.
○ Benedict’s solution put it on with the right side
Put out all the necessary articles To have them readily accessible Any flat surface
needed for the specific care.
Close the bag and put it in one corner To prevent contamination 6 feet away from the PATIENT’S
of the working area.
- Droplet
Proceed in performing the necessary To give comfort and security and
Home visits
nursing care treatment. hasten recovery

After giving the treatment, clean all To protect the caregiver and prevent Several families to be visited
things that were used and perform infection
1. Pregnant who did go back for appointed prenatal
hand washing.
2. 3 day old post-partum
3. A father with tuberculosis on DOTS
Open the bag and return all things
4. A 5 year with measles
that were used in their proper places
after cleaning them.
2….1…..3….4
Remove apron, folding it away from Remove apron, folding it away from
CHARACTERISTICS OF A COMMUNITY:
the person, the soiled side in and the the person, the soiled side in and the
1. Environment- includes the physical, biological, socio-cultural,
clean side out. clean side out. Place it in the bag.
educational and employment milieu

Fold the lining, place it inside the bag The physical environment of the community includes the geography,
and close the bag climate, terrain, natural resources and structural entities (buildings such
as schools, workplaces and homes).
Take the record and have a talk with
the mother. Write down all the The biological environment of the community includes various flora,
necessary data that were gathered, fauna, bacteria, viruses, molds, fungi, toxic substances, and food and
observations, nursing care and water supplies.
treatment rendered. Give
instructions for care of patients in The sociocultural environment of the community reflects the culture,
the absence of the nurse. values, attitudes, and demographic characteristics of the people of the
community.
Make appointment for the next visit For follow-up care
(either home or clinic) taking note of
2. Population behavior or lifestyle – This describes the self-responsibility,
the date and time.
the self-care competency of the people in the community.

3. Human biology – describes the genetic characteristics of population.

 4. Systems of Health care – Describes whether available health care is
that of prevention, promotion, cure and rehabilitation.
Classification of Communities:
1. Urban- high density, a socially heterogeneous population and a
complex structure, non-agricultural occupations; something different
from an area characterized by complex interpersonal social relations.
2. Rural – usually small and the occupation is usually farming, fishing
and food gathering. It is peopled by simple folk characterized by
primary group relations, well-knit and having a high degree of group
feeling.
3. Rurban – a combination of the first two.
COMPONENTS OF A COMMUNITY
I. THE CORE – represents the people that make up the community.
Included in the community CORE are the demographics of the
population as well as the values, beliefs and the history of the people.
Nature and Scope of Demography:
The word demography was derived from the Greek words: demos, meaning
people and graphos, meaning count. Very simply, it is the study by statistical
methods of human population.
More inclusively, it is the study of the size, composition and distribution of
human population and the changes over time brought about by births, deaths
and migration.
The scope of demography thus includes the following aspects, which are
indicated by certain demographic measures:
Population size – the size of the population simply refers to the population
or the number of people that is affected by births, deaths and migration.
Population composition – The composition of the population refers to
the arrangement of the people according to biologic, social, ecological
characteristics such as age, marital status, education, occupation, etc.
Three common that relate to population composition are the following:
a. Sex ratio – This is simply the number of males in a population
divided by the number of females. Since the quotient is usually
just below or above `1, it is multiplied by 100 (and expressed in
percentage) to give it meaning. Thus sex ratio = male/female x
100.
Example:
40 %
40 males for every 100 females
In a community with 400 males and 600 females, the
sex ratio is 66% or 66 males for every 100 females.
b. Age composition – There are two to describe the age
composition of the population
Median age – divides the population into two equal
parts. So if the median age is said to be 19 years old, it
means half of the population belongs to 19 years and
above, while the other half belongs to ages below 19
years old.
young=
40= old =
Dependency Ratio – compares the number of
economically dependent with the economically
productive group in the population. The economically
dependent are those who belong to the 0-14 and 65 and
above age groups. Considered to be economically
productive are those within the 15 to 64 age group. It is
computed by dividing the number of economically
dependent age group by the number of economically
productive age group and multiplied by 100.
 Example:
In a community of 400 economically dependent and 600
economically productive, the dependency ratio is 66% or 66
dependents for every 100 working pop.
c. Age and sex composition – This can be described at the same time using
a population pyramid. It is a graphical presentation of the age and sex
composition of the population. . This is usually expressed in terms of
proportion (or percentage) of people in various age groups of different sex
in a population.
infants=== Estimated number is 3% or 2.7 %
Pregnant women==== 3.5% of the total population
1-4 years==== 11.5%
Population Distribution- The distribution of the population in space can be
described in terms of urban-rural distribution, population density and
crowding index. These measures helps the community health care worker
decide how meager resources can be justifiably allocated based on
concentration of population in a certain place.
a. Urban-rural distribution simply illustrates the proportion of the
people living in urban compared to the rural areas.
b. Crowding index will describe the ease by which a communicable
disease will be transmitted from one host to another susceptible
host.
This is described by dividing the number of persons in a
household with the number of rooms used by the family for
sleeping.
10 people
2 rooms used
10/2===== 5
c. Population density will determine how congested a place is and
has implications in terms of adequacy of basic health services
present in the community.
It can be computed by dividing the number of people living
in a given land area.
Population Dynamics – This refers to the changes in size,
composition or distribution of the population over time. Changes in
the population can be reflected by measures of migration and
population growth. However, measures of migration are not being
used very much because of incomplete data.
a. Rate of Annual Increase – This refers to the difference
between birth and death rates per 1000 population. Thus,
RNI = CBR (Crude birth rate) – CDR (Crude death rate)
5==== 5 people added to the population 1000pop
b. Average Annual Increase – This refers to the change in
population size with reference to the base population
(population at an earlier date) expressed either in absolute
or relative terms,
1. Absolute change: measures the number of people that are
added to the population per year; expressed in numerical
increase; obtained by the formula:
Pt - Po where: Pt = population at a later date—5500
T
Po = population at an earlier date 5000
T = number of years between time 0 and
time t---- 5years
100/year
2. Relative increase = is the actual difference between the two
census counts expressed in per cent relative to the population
size made during at an earlier census.
Relative increase = Pt - Po
Po
SIGNIFICANCE OF DEMOGRAPHY TO COMMUNITY HEALTH
1. Anticipate health problems. For example, age structure gives an idea
of the nature of health problems in a community. In a young population,
one may expect a predominance of certain childhood and communicable
diseases while in the old population, there maybe a high prevalence of
chronic, degenerative diseases.
2. Determine availability and need for resources. In the planning of
public health programs, population data are used in determining the
need for and allocating resources in terms of manpower and materials.
EPI Infants =
Pregnant women
3. Serve as a tool and basis for evaluation.
SOURCES OF DEMOGRAPHIC DATA
1. National Census. A census is a complete enumeration of population
taken at specified points in time.
If the count considers all persons wherever they maybe on census day, it
is called de facto census.
However, if it considers persons only in their places of residence, it is
termed as de jure census.
2. National Registration of vital events. Most nations have laws that
make it compulsory to register each birth (within 30 days in the Phils.)
after they occur.
RA3753
PD651 birth must be done within 30 days after occurrence of birth
3. Sample surveys. The sample survey is the study of a sub-group of
population that is a representative sample of the total population to
obtain more detailed information about the population.
Death
Age= Age as of last birth
I. The eight (8) subsystems of the community
1. Housing – What type of housing facilities are there in the
community; are there enough housing facilities available;
are there housing laws/regulations governing the people?
What are these?
2. Education – These includes laws, regulations, facilities,
activities affecting education, ratio of health educators to
learners, distribution of educational facilities, who utilizes
these; what informal educational facilities and activities exist
in the community?
3. Fire and Safety – Fire protection facilities and fire prevention
activities, distribution of these.
5. Politics and government – Political structures present in the
community, decision-making process/pattern, leadership
style observed, etc…
6. Health – Health facilities and activities; distribution,
utilization, ratio of providers to clientele served; priorities in
health, programs developed, etc.
7. Communication – Systems, types of community existing,
forms of communication, be it formal or informal, vertical or
horizontal; etc.
8. Economics – Occupation, types of economic activities,
income, etc….
9. Recreation–Recreational activities/facilities: types,
consumers, appropriateness to consumers, etc…
A HEALTHY COMMUNITY….. Primary Health Care approach

M … prompts its members to have a high degree of awareness that “we are FACTORS THAT AFFECT COMMUNITY HEALTH
community” - Political
- Socio-economic
M … uses its natural resources while taking steps to conserve them for future - Heredity
generations. - Environment
- Behavior
M … openly recognizes the existence of sub-groups and welcomes their - Health Care Delivery System
participation in community affairs
EFFECTS OF A HEALTHY COMMUNITY
M … is prepared to meet crises
Development
M … is a problem-solving community; it identifies, analyzes and organizes to
Vital statistics – is the application of statistical methods and techniques to
meet its own needs the study of vital facts, such as those concerning
Births,
M … has open channels of communication that allows information to flow Deaths and
among all sub-groups of its citizens in all directions Illnesses.

M … seeks to make each of its system’s resources available to all members - Statistical data, which relate the total number of various kinds of biologic
or vital events (like births, marriages, illnesses and deaths) to the size
of the community
and characteristics of the affected population.

M … has legitimate and effective ways to settle disputes and meet needs Three categories of Vital Statistics:
that arise within the community A. Fertility or Birth rates

M … encourages maximum citizen participation in decision-making 1. Crude Birth Rate – The Crude birth rate is only a rough measure of
M … promotes a high level wellness among all its members. fertility in the population since it makes use of the mid-year
population (which ignores the number of men and women incapable
of child bearing) as its denominator. However, it has its advantages.
ELEMENTS OF A HEALTHY COMMUNITY Used to compute for the rate of annual.
- People are partners in health care
- People work together to attain goals For one, the data are easy to obtain, making the rate readily available.
- Physical environment promotes health, safety, order and cleanliness Secondly, the rate can be used in determining population growth by
- Safe water and nutritious food subtracting the crude death rate from it. This rate is obtained using
the following formula:
- Families provide members with basic needs
- Available, affordable health care
 CBR= Total live births in a calendar year x 1000
Mid-year population for that year
2. General fertility Rate (GFR) – This rate is a more refined measure than
crude birth rate because the denominator makes use of the number of
women of a child-bearing age.
However, it is still limited in the sense that not all women of child-
bearing age are expected to give birth for various reasons. This rate
is obtained by the following formula:
GFR= Total live births in the calendar year x 1000
Mid-year population of women of
Child-bearing age (15-44 or 48 years) for that year
GFR= 10 births/ 1000 pop of women between 15-44 or 48
3. Age-Specific Fertility Rate – One of the most accurate refinements made
in the study of fertility is the age-specific fertility rate. This rate permits
a more in-depth study of the differences in fertility at specific ages
throughout the reproductive period and the impact of birth control
measures on fertility.
The age-specific fertility rate is obtained by the following formula:
= total live births to women of X years x 1000
Mid-year population of women of X years
B. Mortality/Death rates
1. Crude death rate (CDR). The crude death rate is a measure of the force
of mortality or the probability of dying in a population.
However, death rates are influenced to a large extent by the age and sex
composition of the population. For example, elderly people have higher
death rates and males than females in most causes at most ages.
Therefore, comparisons of population groups that are radically different
in age and sex composition may give misleading conclusions if the crude
death rate is used.
To overcome these difficulties, standardized death rates are estimated,
whereby adjustments are made for the age and sex compositions of
populations.
Comparisons can thus be made between these standardized rates where
age and sex are held constant. The crude death rate is obtained by the
following formula:
CDR= total deaths in a calendar year x 1000
Mid-year population for that year
Lifespan of females is longer than that of males
Increasing life span 68-72
Developing countries== longer
65----- “New middle age”
2. Age-Specific Death Rate. This rate gives a better picture of the force of
mortality in a given population than the Crude Death rate since the age
factor (which affect death rate to a large extent) is held constant. This
rate is merely the crude death rate calculated for each age group. The
age-specific death rate is obtained by the following formula:
= total deaths, specific age-group, calendar year x 1000
Mid-year population, same age-group, same year
For ages 1-5---- 15
15 deaths aging 1-5 for every 1000 population aging 1-5 years old
3. Age and Sex-specific death rate. This rate is similar to the age-specific
death rate but specifies the sex as well. It is obtained by the following
formula:
= total deaths, age group and sex, calendar year x 1000
Mid-year population, same age-group and sex and year
4. Cause-specific death rate. This rate specifies the cause rather than the
age and sex. It is obtained by the following formula:
= total deaths from a particular disease in a calendar year x 1000
Mid –year population in a calendar year
This rate may also be refined as to age and sex, in which case it becomes
the age, sex and cause-specific death rate.
5. The proportional mortality rate. This rate denotes the percentage of
all deaths attributed to a certain disease. It is used in ranking the cause
of death by magnitude of frequency. The ten leading causes of mortality
is a popular means of showing the common health problems for a given
geographic area, age and sex.
 However, unlike the other mortality rates, it does not measure the
probability of dying in a given population because the denominator does
not represent the population at risk. The proportional mortality rate is
obtained by the following formula:
=total deaths from a particular cause in a calendar year x 100
Total deaths from all causes in the same year
Factor 100=== per cent
48 ---total
Cancer---10…. 10/48 x 100
Heart 15----------15/48 x 100
COVID 19 ---=
Note that it is always expressed in percentage since the factor used is 100.
The SWAROOP’S INDEX is another proportional mortality indicator. It gives
the percentage of all deaths, which occur in persons 50 years and above as
shown in the following formula:
= total deaths in persons 50 years and above x 100
total number of deaths for all ages=== 48
50 years and 1bove ==== 15
15/48 X 100=31%
31% dies after age 50
69 % dies before age 50
Good or bad
Die young===== poor health
The Swaroop’s index is directly proportional to the health status of a
population. For example a Swaroop’s index of 80% means that only 20% of
the population are dying before the age of 50 years, which is a good indication
of the health of a population. A low index, on the other hand, implies the life
expectancy is short and people die more of acute and communicable
diseases.
6. Case Fatality Rate (CFR). This rate measures the lethality or the killing
power of a disease or injury as expressed in terms of percentage. For
example, rabies and meningitis are known to have a high CFR while measles
or mumps are known to have a low CFR.
Cancer =5/10= 50%
COVID=2/100 = 2%
To determine the case fatality rate of a disease, it is necessary to follow-up
the
- Cases for a defined period such that deaths occurring beyond the
period could reasonably be directly related to the disease under
study. Otherwise if the follow- up period is indefinite, all cases will
ultimately die. Thus, this rate is useful in case of acute infectious
diseases, assuming that all new cases are reported and most deaths
occurred in a relatively short time after diagnosis.
The CFR may be used to determine how well the treatment for a certain
disease has succeeded or is succeeding. The formula for obtaining this rate is
as follows:
=total deaths from a particular cause during a specific time period x 100
Total cases of the same cause followed-up during the same time
period
5 cases rabies
4 died
CFR ===⅘ x 100==== 80%
20 cases
1 died
7. Infant Mortality Rate (IMR). This rate is considered one of the most
sensitive indices of the health conditions obtained in a population. Unlike
the crude death rate, which includes death rates from old age,
degenerative diseases and other causes not readily preventable by public
measures, the IMR is closely linked with preventable or environmental
factors. Infant deaths are associated with acute communicable diseases
and such factors as poor environmental sanitation and poor hygiene; in
general inadequate health services. This rate is obtained by the following
formula:
 IMR= total deaths, less than 1 year of age in a calendar year x 1000
Total live births in the same year
Note that infant deaths are not actually divided by the actual
population of that age because the census data are obtained only for certain
years and are likely to fluctuate considerably between census years. Thus, the
number of live births provides a more reliable and readily available figure for
the denominator.
Because of the generally high mortality that occurs in the first year of
life, further division of the IMR into the neonatal (first month or 28 days of
life) and post-neonatal (after the first month to one year of age) mortality
rates may be made. Calculations of these rates consist merely of substituting
the age group less than 1 year of age to the two age group mentioned.
NMR = total deaths, 28 days of life, calendar year x 1000
Total live births in the same year
PMR = total deaths after the 1st month to 1 year, calendar year x 1000
Total live births in the same year
11. Perinatal Mortality Rate. (PMR). With the continuing improvement in
8. Fetal Death Rate = Fetal deaths, which include abortions and still
births, are generally attributed to prenatal causes and are therefore
influenced more by endogenous than environmental factors. The
term fetal death has been defined by WHO as “death prior to
complete expulsion or extraction from the mother of a product of
conception, irrespective of the duration of pregnancy”. The death is
indicated by the fact that after such separation, the fetus does not
breathe nor show any evidence of life such as beating of the heart,
pulsation of the umbilical cord or definite movement of voluntary
muscles. The accepted formula for the fetal heart rate is:
= total deaths, 28 weeks of gestation & over, calendar year x 1000
Total live births in the same year
The appropriate denominator is the number of conceptions or
pregnancies, which maybe directly derived at by adding all fetal deaths and
live births. Since fetal deaths (or abortions) are seldom reported, the uses of
live births is universally accepted. For the same reason, better figures are
obtained if the numerator is limited to late fetal deaths (or still births).
10. Maternal Mortality Rate (MMR). This rate measures the risk of dying
from causes with childbirth. Maternal death is defined as the death of a
mother directly due to pregnancy, labor and puerperium within 90 days of
delivery. Deaths of mother or pregnant women are not due to causes
previously mentioned are not included in maternal deaths. The MMR is
obtained from the following formula:
MMR = total maternal deaths in a calendar year x 1000
Total live births in the same year
Ideally, the denominator should be the number of pregnant women
during the year under review in the absence of the system of reporting
pregnancies; the number of live births is used as a convenient approximation
of the number of pregnancies.
maternal care in general and the pre-natal in particular, the maternal
mortality rate has declined considerably especially in developed countries.
This situation has reduced the importance of this rate as an index of the
quality of health care available in a country.
In view of this, increasing attention has been given to peri-natal deaths (i.e.,
deaths of the fetus or neonate occurring around the time of birth). The
computation of perinatal mortality is now preferred over that of still birth
and neonatal death rates, as it has been realized that many fetal deaths in
late pregnancy and neonatal deaths in the first week of life may be
attributed to similar underlying conditions/factors. To separate the two
events gives incomplete information so that certain factors may be
overlooked rather than identified.
 It is now accepted that perinatal mortality rate is a good index of the quality
of maternity care available since maternity care is concerned both in
improving the welfare of the fetus and in insuring the birth of a healthy
child.
2. Prevalence Rate. When chronic diseases constitute the major medical
The standard formula for computing perinatal mortality rate is:
Fetal deaths, 28 weeks and over gestation + early
= neonatal deaths, 1 week of age in a calendar year x 1000
Total live births in the same year
C. MORBIDITY/SICKNESS RATES
1. Incidence Rate. In times and in areas in which infectious diseases are the
predominant medical problems, reporting of new cases of specific diseases
by physicians to health authorities provides an important measure of
disease risk—i.e., the probability of a healthy individual contracting a
particular disease during the specified time period. In reporting cases, one
individual should be reported only once; relapses or exacerbations are not
included. However, reinfection with a disease is another matter.
The incidence rate measures the rapidity of occurrence of new cases.
It answers the question, “how frequently does a disease occur within a given
period of time, say a year?” It is usually used in the study of acute diseases
(when it is usually higher than prevalence), in outbreaks or epidemics (study
of causation) and secular trends (changes in disease patterns over short
periods of time). It can be made a specific for age, sex, etc., in the same
manner as age specific mortality rates.
Incidence rate is obtained by the following formula:
= No. of new cases during a specified time x Factor
POPULATION IN THE AREA DURING THAT TIME
A refinement of the incidence rate is the ATTACK RATE (AR), which is
used only for a limited population group and time period, usually during an
outbreak or epidemic. It is obtained by the ff. Formula:
=no. of new cases of a disease in a time period
Population at risk during that time period x100
problem incidence rates cannot easily be obtained since few such diseases
are reportable. Reporting can usually be demanded only if one case of disease
involves exposure of other persons and disease constitutes a danger to public
health. Thus, the prevalence rate is the more commonly used morbidity
measure in chronic disease.
Prevalence rate is a measure of the status of a particular disease
within a given point or interval of time. It answers the question, “what
proportion of the population are actually ill with a particular disease or are
infected with a particular agent?” Unlike the incidence rate, therefore, the
prevalence rate does not measure the probability of getting a particularly
disease in a specified time period.
Prevalence rate is usually used in the study of chronic diseases (when
it is usually higher than incidence) and in computing for carrier rates, antibody
levels, etc. As such, it is a valuable tool for administrative purposes.
Prevalence rate is obtained by the following formula:
Point prevalence= no. of cases existing (old and new) at a time
Population surveyed during that time x100
Period prevalence
= No. of cases existing (old and new) at a given interval of time
Population surveyed during that interval of time x100
INTERPRETATION OF VITAL STATISTICS
A. SOURCES OF DATA
1. Vital registration records. The Civil Registry Law (Act No. 3753) requires
the registration of all births and deaths including fetal deaths.

2. Weekly reports from field Health Personnel. Data on notifiable diseases
are based on information gathered from field health personnel. The Law on
Reporting Notifiable Diseases I(Act No. 3573) provides that any case of
notifiable disease shall be reported weekly through the nearest provincial and
city health officer to the Disease Intelligence Center (DIC) of the Ministry of
Health.
3. Population censuses
B. CLASSIFICATION OF DATA
Guidelines in the classification of data:
1. Classification of Vital Events. All vital events are registered and
reported by place of occurrence, not by place of residence. Classified
into regions, provinces, and cities.
2. Reckoning of age. Age should be recorded as of the last birthday.
3. Classification of disease and causes of deaths.
The following are factors that should be taken into consideration in the
interpretation of rates:
1. Definition/Classification of the event in either numerator or
Denominator.
This refers to the definition of certain terms like cause of death or
maternal death and to the accuracy of diagnosis of certain diseases.
2. Accuracy of the Court of event or population concerned.
This refers mainly to the completeness or adequacy of coverage of the
count. In the Philippines, although the law provides for the compulsory
registration of births and deaths and the reporting of notifiable diseases,
there are still deficiencies in the observance of the law.
Factors that may affect the reporting/registration of vital events:
a. Not all diseases are notifiable/reportable in the country, so that it is
very difficult to obtain data on these diseases, which are not
reportable
Diseases which will be monitored by the rural health Midwife at least
weekly:
¸ Measles
¸ Acute poliomyelitis
¸ Severe acute diarrhea
¸ Neonatal tetanus
¸ AIDS
Diseases which should be reported within 24 hours:
¸ Acute poliomyelitis
¸ Measles
b) Certain diseases like venereal diseases carry a social stigma so that
they are often times not discovered/reported easily.
c) Usually, only frank cases tend to be reported so that the milder forms
of certain diseases remain unnoticed.
d) Ignorance of or plain disregard for registration result to under
registration of such events.
3. Use of correct numerator/denominator. If the computation of the
statistical indices for the Philippines, standard formulas are used.
4. Magnitude/nature of the rate. When comparing rates, one should be sure
that the rates cover the same time period and that the groups under study
are comparable with regard to important factors that may influence the
magnitude of the rate.
Importance of Vital statistics in public health:
- Serve as indices to assess the health status of the community.
- To pinpoint particular health problems.
- Determine the cause and effect of health problems.
- Directs attention to particular health problems.
- Evaluates needs or failures of public health programs.
- Create administrative standards for public health activities.
- Serve as justification demanding support for public health programs.