CHARACTERSITICS OF PUBLIC HEALTH

1. It deals with preventive rather than curative aspects of health.

2. It deals with population level rather than individual-level health issues.

10 ESSENTIAL ELEMENTS of PUBLIC HEALTH

HEALTH A status of complete physical, mental and social well-being

andnot merely the absence of disease or infirmity regarded as person’s physical and psycholog
ical capaciity to establish and maintain balance. – World Health Organization
Aspects of Health

1. Physical Health- refers to condition which enables

a person to maintain a strong and healthy body.

2. Mental Health- refers to how a person thinks of himself, control his

emotions and adjust to environment.

3. Social Health- refers to ways a person feels, think and acts towards everybody around him.

Health or disease is expressions of the success

or failure of a person to respond adaptively to environmental challenges.

HEALTH- successful defense of the host against forces landing to disturb body equilibrium

DISEASE-
failure of the body defense mechanism to cope with forces tending to disturb body equilibrium

What Factors Determine Our Health?

 Family Health History

 Environment
 Behaviors/Lifestyles
DETERMINANTS of HEALTH

1. Income and social status- higher income and social status are linked to better health

2. Education- low education levels are linked with poor

health, more stress and lower self confidence

3. Physical environment-
safe water and clean air, healthy workplace, safe houses, communities and roads all contribu
te to good health.

4. Employment and working conditions-

people in employment are healthier, particularly those who have more control over their wor
king conditions.

5. Social support networks- greater support from families, friends and communities is linked
to a better health

6. Culture- customs, traditions and the beliefs of the family and community all affect the health

7. Genetics- inheritance plays a part in determining lifespan, healthiness and

the likelihood of developing certain illness.

8. Personal behavior and coping skills-

balanced eating, keeping active, smoking, drinking and how to deal with life’s stresses and ch
allenges all affect health

9. Health services- access and use of services that prevent and treat disease influence health
10. Gender- men and women suffer from different types of diseases at different ages.

HISTORY OF PUBLIC HEALTH in the PHILIPPINES

Pre-American Occupation ( up to 1898 )

American Military Government ( 1898-1907)

Philippine assembly (1907-1916)

The Jones law (1916-1936)

The Commonwealth (1936-1941)

Japanese occupation ( 1941-1945)

Post World war II (1945-1972)

Post EDSA revolution (1986 to present)

1. Pre-American Occupation

1577- Public health began at the old Franciscan Convent in Intramuros where Fr. Juan
Clemente put up dispensary for treating indigents in Manila.

-San Juan de Dios Hospital

The influential Spanish clergy established the first medical institutions in the Philippines.

A few of these, such as the Hospital San Juan de Dios, remain to this day.

 During Spanish Time

Creation of Vaccinators to prevent smallpox

To show that the vaccines were not meant to harm, it was first administered to the Governor-
General’s very own children.

By May 29, 1805, around six to seven thousand adults and children were vaccinated in
Manila, Tondo, and Cavite.

Typhoons brought heavy rainfall which caused widespread flooding in low-lying areas. Water-
borne diseases like cholera were rampant during these periods.

Creation of Board of Health

First medical school in the Philippines- UST

School of Midwifery

Public Health Laboratory

Forensic Medicine

 Hospital before the Americans came to Philippines

General Hospitals
San Juan de Dios Hospital

Chinese General Hospital

Hospicio de San Jose in Cavite

Casa dela Caridad in Cebu

Enfermeria de Sta. Cruz in Laguna

Contagious Hospitals

San Lazaro Hospital

Here the facility became known as the Hospital de San Lazaro, in honor of the patron saint of
lepers.

The name was given after the hospital undertook the care of 150 lepers sent to the Philippines
by the Japanese emperor Iemitsu in 1632 at the time of Governor-General Juan Nino
de Tabora.

Hospital de Palestina in Camarines Sur

Hospital delos Lesporosos in Cebu

Hospital de Argencina in Manila for smallpox and cholera

2. American Military Government

A. Control of epidemics such as:

a.cholera,

b.small pox

c.and plague

B. Fight against communicable diseases such as:

common cold,

HepatitsA-D,

chickenpox,

SARS,

flu

mumps,

malaria,

herpes,

STD, and

measles

C. Projects and activities:

1. Garbage crematory

2. First sanitary ordinance and rat control

3. Cholera vaccine was first tried

4. Confirmed that plague in man comes from infected rat

5. Opened the UP College of Medicine

6. Establishes Bureau of Science

During the battle for liberation of Manila, the Philippine General Hospital could not handle the
casualties alone.

Thus, the US Army converted an old school building into a make shift civilian hospital the North
General Hospital. Following the name of its first director, it was later named Jose R. Reyes
Memorial Medical Center.

The Mandate of Public Health (1918-1941)

3. Philippine Assembly

Hygiene and Physiology were included in curriculum of public elementary school

Anti-TB campaign was started

Philippine Tuberculosis Society was organized

Opening of PGH (Philippine General Hospital)

Use of anti-typhoid vaccine was initiated

Dry vaccine against small pox was first use

Mechanisms of transmission of dengue fever through Aedes aegypti was studied

Establishment of School of Hygiene and Public Health

National Research Council of the Philippines was organized

BS in Education Major in Health Education was opened in UP

(PPHA) Philippine Public Health Association was organized

4. JONES LAW YEARS

1. Retrogression rather than progression in so far as the health was concern

Increase CDR / Crude Death Rate

Increase IMR / Infant Mortality Rate

Increase Morbidity

2. Increase deaths from smallpox, cholera, typhoid, malaria and TB

3. Re-organization of the health service and encouraged effective supervision

Study the cause and prevalence of typhoid fever

Schick test was used to determine the causes of diphtheria

Campaign against Hookworm was launched

Anti-dysentery vaccine was first tried

First training course for sanitary inspector was given

Women and child labor law was passed

5. COMMONWEALTH PERIOD

1. The epidemiology of life threatening disease was studied- diphtheria, dengue

2. Research in the field of health was promoted

3. UP School of Public Health was established

4. Development of Maternal and Child Health (MCH)

5.1939– Creation of Dept. of Public Health and Welfare - Dr. Jose Fabella as the First secretary

6.1940- Bureau of Census and Statistics was created to gather vital statistics

7. In spite of development
Inequitable distribution of health services remained a problem

80% of those who died were never given medical attention

CONTINUE SA PPT :>

Community
Health / Public
Health
 Community

It is a group of people with

common characteristics or
interests living together
within a territory or
geographical (physical)
boundary.
 Community
“A collection of people who
interact with one another and
whose common interests or
characteristics form the basis
for a sense of unity or
belonging”
(Allender et al., 2009, p.6)
 Community
Community is a group of
people who have common
characteristics definable by
location, race, ethnicity, age,
occupation, interests in
particular problems or
outcomes, or common bonds.
 Community
Determinants of Population
1.Race
2.Nationality/Ethnicity
3.Sexual Orientation
4.Age or Age Group
5.Geographic locality
 Community
What is Community Health?
Community Health: is the status of a
defined group of people and the
actions and conditions to promote,
protect, and preserve their health.
Population Health: is the health
status of persons not organized and
without identity as a group or locality.
COMMUNITY HEALTH/PUBLIC
HEALTH
A. Environmental sanitation
B. Control of Community
infection (communicable
disease)
C. Education of the individual
in principles of personal
hygiene
D. Organization of Medical and nursing
services for early diagnosis and
preventive treatment of diseases
E. Development of social machinery
which will ensure everyone as
standard living adequate for
maintenance of life
COMMUNITY HEALTH/PUBLIC HEALTH
A. Environmental sanitation
B. Control of Community infection (communicable
disease)
C. Education of the individual in principles of
personal hygiene
D. Organization of Medical and nursing
services for early diagnosis and preventive
treatment of diseases
E. Development of social machinery which
will ensure everyone as standard living
adequate for maintenance of life
Two broad areas of preventive
medicine
1. Public Health- includes
programs and activities
directed at community level
and will benefit everyone or
individuals who are not
currently under the care of
physician.
 Two broad areas of preventive
medicine
1. Risk Factor Evaluation- includes
programs and activities directed at
individuals who are currently under
the care of physician who evaluates
them for high-risk factors that can
cause disease, educate them about
good habits and screens them for
appropriate conditions.
Two broad areas of preventive
medicine
 Community
Understanding a Community
In order to evaluate one’s community, one
must understand the factors that effect the
health of a community.
The three main factors and determinants
of community health are as follows:
1. Physical Factors
2. Social and Cultural Factors
3. Individual Behaviors
 Factors of Community
Health
1. Physical Factors:
Examples:
Geography: Dry, Tropical
Environment: Smoggy, (polluted)
Community Size: 244,000
Industrial Development:
Metropolitan, Rural
 Factors of Community
Health
2. Social and Cultural Factors:

1. Traditions, Prejudices, Beliefs

2. Economy
3. Politics
4. Socioeconomic Status
 Factors of Community
Health
3. Individual Behavior
The behavior of the
individual community
members contributes to
the health of the entire
community.
DETERMINANTS OF HEALTH &
DISEASE OF THE COMMUNITY
The health status of a community is
associated with a number of factors
such as:
a. Health care access
b. Economic conditions
c. Social and environmental
issues
d. Cultural practices
VARIABLES influencing Health
Status, Beliefs & Practices

1. INTERNAL VARIABLES : include those which are

usually non-modifiable such as:
a. Biologic dimension - genetic makeup, sex, age,
and developmental level all significant to a person’s
health.
b. Psychological dimension - emotional factors which
include mind-body interactions and self-concept.
c. Cognitive dimension - intellectual factors which
include lifestyle choices and spiritual and religious
beliefs.
VARIABLES influencing Health
Status, Beliefs & Practices
2. EXTERNAL VARIABLES : the
macrosystem which include:
a. Environment : geographical locations
determine climate, and climate affects
health; environmental hazards.
b. Economics : standards of living
reflecting occupation, income and
education is related to health, morbidity
and mortality.
VARIABLES influencing Health
Status, Beliefs & Practices
c. Family and cultural beliefs : the family
passes on life patterns of daily living and
lifestyles to offspring (e.g. physical/emotional
abuse or climate of open communication).
Culture and social interactions also influence
how a person perceives, experiences, and
copes with health and illness.
d. Social support networks : political/systems of
governance; religion/church; mass media.
VARIABLES influencing Health
Status, Beliefs & Practices

3. HEALTH BELIEF MODEL : refers to

the relationship between a person’s belief
and his behavior in health. It pertains to
three components of an Individual’s
perception :
1. Susceptibility to an illness
2. Seriousness of an illness
3. Benefits of taking the action
Example: In one HIV infection study
VARIABLES influencing Health
Status, Beliefs & Practices

4. HEALTH PROMOTION
MODEL :
directed at increasing client’s well-
being.
* Goal : enhance level of
wellness.
VARIABLES influencing Health
Status, Beliefs & Practices
5. WHO DEFINITION (1978) : a state of
complete physical, mental, and social
well-being, not merely the absence of
disease or infirmity(sickness).
✓Health is a social phenomenon.
✓It is an outcome of multi-causal theories
of health and disease.
VARIABLES influencing Health
Status, Beliefs & Practices

5. WHO DEFINITION (1978)

✓It is an outcome or by-product of the interplay
of societal factors :
a. Ecological :
1. Biological
2. Physical
b. Economic
c. Political
d. Socio-cultural
COMMUNITY HEALTH
A part of paramedical and medical
intervention or approach which is
concerned with the health of the whole
population.
A discipline that concerns with the study
and betterment of the health
characteristics of biological communities.
COMMUNITY HEALTH

Its aims are :

1. Health promotion
2. Prevention of disease
3. Management of factors
affecting health
 COMMUNITY HEALTH
PANDEMIC
- wide spread; epidemic over a wide geographic
area and affecting a large portion of the
population
EPIDEMIC
- spreading rapidly and extensively by infection
and affecting many individuals in an area or a
population at the same time.
-an outbreak of a contagious disease that
spreads rapidly and widely
 Endemic: A disease that exists
permanently in a particular region or
population. Malaria is a constant worry in parts of
Africa.

Epidemic: An outbreak of disease

that attacks many peoples at about the same
time and may spread through one or several
communities.
Pandemic: When an epidemic
spreads throughout the world.
EPIDEMIOLOGICALTRIAD
ENVIRONMENT

AGENT HOST
 AGENT

• The first link in the chain of disease transmission is a

disease agent.
• The disease agent is defined as a substance, living or non
living or a force, tangible or intangible, the excessive
presence or relative lack of which may initiate or
perpetuate a disease process.
• A disease may have a single agent, but more factors are
responsible for disease transmission.
BIOLOGICAL AGENTS

• VIRUS
• BACTERIA
• PROTOZOVA
• FUNGUS

CHARACTERISTICS:
- Infectivity
- Pathogenicity
- virulence
 PHYSICALAGENTS
• Exposure to excessive
heat, cold, humidity,
pressure, radiation,

elecricity, sound etc..

 CHEMICALAGENTS
• ENDOGENOUS • EXOGENOUS
MECHANICALAGENTS
NUTRITIONALAGENTS
SOCIALAGENTS
 OTHERS
• Hormones

• Lack of part or structure

• Chromosomal factors

• Immunological factors
HOST
• Human being is
referred

• to as “ soil” and the

disease agent as “

seed”
DEMOGRAPHIC FACTORS
BIOLOGICAL FACTORS
SOCIO ECONOMIC FACTORS
LIFE STYLE FACTORS
ENVIRONMENTAL FACTORS
1. PHYSICAL ENVIRONMENT
BIOLOGICAL ENVIRONMENT
PSYCHO SOCIAL
ENVIRONMENT
COMMUNITY
ORGANIZING
Community Organizing
To find methods and procedures to
help deal with social issues within the
community.
Example: Cancer from tobacco use is a
social health issue in Community A.
Therefore community organizing would
involve methods and procedures to deal
with the issue such as canvasing or an
awareness campaign.
Community Organizing
To find methods and procedures to
help deal with social issues within the
community.
Example: Cancer from tobacco use is a
social health issue in Community A.
Therefore community organizing would
involve methods and procedures to deal
with the issue such as canvasing or an
awareness campaign.
 Community Organizing
Process
1. Recognize the Issue
2. Gain Community Entry
3. Organize People
4. Asses the Community
5. Set Goals and Priorities
6. Arriving at a Solution
 Community Organizing
Process
7. Selecting Strategies
8. Implementing Plans
9. Evaluating outcomes
10.Maintaining outcomes
11. (Source: McKenzie, Pinger, Kotecki, 2012).
Primary Health Care (PHC) in the Philippines

Introduction

Primary Health Care (PHC) is 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 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-
determination.

 Health Education
 Treatment of Locally Endemic Diseases
 Expanded Program on Immunization
 Maternal and Child Health
 Provision of Essential Drugs
 Nutrition
 Treatment of communicable and non-communicable diseases
 Safe water and good waste disposal

Goals

The ultimate goal of primary health care is better health for all. WHO has identified five key
elements to achieving that goal:

 Reducing exclusion and social disparities in health (universal coverage reforms);

 Organizing health services around people’s needs and expectations (service delivery /
reforms);
 Integrating health into all sectors (public policy reforms);
 Pursuing collaborative models of policy dialogue (leadership reforms); and
 Increasing stakeholder participation.
History

A brief history of Primary Health Care is outlined below:

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)

October 19, 1979.The President of the Philippines (Ferdinand Marcos) issued Letter of Instruction
(LOI) 949 which mandated the then Ministry of Health to adopt PHC as an approach towards
design, development, and implementation of programs which focus health development at
the community level.

Rationale

Adopting primary health care has the following rationales:

 Magnitude of Health Problems

 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 Isolation of health care activities from other development activities
Objectives

 Improvement in the level of health care of the community

 Favorable population growth structure
 Reduction in the prevalence of preventable, communicable and other disease.
 Reduction in morbidity and mortality rates especially among infants and children.
 Extension of essential health services with priority given to the underserved sectors.
 Improvement in basic sanitation
 Development of the capability of the community aimed at self- reliance.
 Maximizing the contribution of the other sectors for the social and economic
development of the community.

Types of PHC workers

There are two types of primary health care workers in the Philippines:

 Barangay Health Worker or Village Health Worker

 Intermediate level Primary Health Worker

Four Pillars

 Active Community Participation

 Intra and Inter-sectoral linkages
  Use of appropriate technology
 Support mechanism made available

Major Strategies of PHC

 Elevating health to a comprehensive and sustained national effort

Attaining health for all Filipinos will require expanding participation in health and health-related
programs whether as service provider or beneficiary. Empowerment to parents, families and
communities to make decisions of their health is the desired outcome.

Advocacy must be directed to national and local policy making to elicit support and
commitment to major health concerns through legislations, budgetary and logistical
considerations.

 Promoting and supporting community managed health care

The health in the hands of the people brings the government closest to the people. It
necessitates a process of capacity building of communities and organization to plan,
implement and evaluate health programs at their levels.

 Increasing efficiency in health sector

Using appropriate technology will make services and resources required for their delivery,
effective, affordable, accessible and culturally acceptable.
The development of human resources must correspond to the actual needs of the nation and
the policies it upholds such as PHC.

The Department of Health (DOH) continue to support and assist both public and private
institutions particularly in faculty development, enhancement of relevant curricula and
development of standard teaching materials.

 Advancing essential national health research

Essential National Health Research (ENHR) is an integrated strategy for organizing and
managing research using intersectoral, multi-disciplinary and scientific approach to health
programming and delivery.

Elements of PHC

The following are the eight (8) essential elements of primary health care:

 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.

 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.

 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

 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.

 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.

 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.

 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.

 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 is used to treat certain bacterial infections, such as pneumonia (a

lung infection), bronchitis (infection of the tubes leading to the lungs), and infections of the
urinary tract, ears, and intestines;

Paracetamol is a common painkiller used to treat aches and pain. It can also be used to
reduce a high temperature;

Amoxycillin is used to treat certain infections caused by bacteria;

Oresol or Oral Rehydration Salts to replace fluids and electrolytes or body salts lost to diarrhea
or vomiting;

Nifedipine is a medicine used to treat high blood pressure;

Rifampicin, INH (isoniazid) and Pyrazinamide and Ethambutol are drugs of choice in
the treatment of Tuberculosis;

Streptomycin is an antibiotic medication used to treat a number of bacterial infections;

Albendazole or anti-worm medication used to treat certain infections caused by worms such
as pork tapeworm; and

Quinine is a medication used to treat malaria.

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 - 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.

The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States
in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now
and into the future. At its heart are the 17 Sustainable Development Goals (SDGs), which are an
urgent call for action by all countries - developed and developing - in a global partnership.

They recognize that ending poverty and other deprivations must go hand-in-hand with
strategies that improve health and education, reduce inequality, and spur economic growth –
all while tackling climate change and working to preserve our oceans and forests.

2012 United Nations Conference on Sustainable Development (Rio+20, Member States agreed
to launch a process to develop a set of sustainable development goals (SDGs) to succeed the
Millennium Development Goals (MDGs), whose achievement period concludes in 2015.
The SDGs are to address all three dimensions of sustainable development (environmental,
economic and social) and be coherent with and integrated into the United Nations global
development agenda beyond 2015. The envisaged SDGs have a time horizon of 2015 to 2030.

The Millennium Development Goals (MDGs) are part of the Millennium Declaration by 189
countries, including 147 Heads of State, in September 2000. The goals and targets are inter-
related and should be viewed as a whole. Built on the outcomes of the international
conferences of the 1990s, the Millennium Declaration marked a strong commitment to the right
to development, to the eradication of the many dimensions of poverty, and to gender equality
and the empowerment of women. The Declaration mainstreams into the global development
agenda eight mutually reinforcing goals, to be achieved by 2015, that are driving national
development and international cooperation.

 Goal 1. Eradicate extreme poverty and hunger

Target 1. Halve, between 1990 and 2015, the proportion of people whose income is less than
one dollar a day

Target 2. Halve, between 1990 and 2015, the proportion of people who suffer from Hunger

 Goal 2. Achieve universal primary education

Target 3. Ensure that, by 2015, children everywhere, boys and girls alike, will be able to
complete a full course of primary schooling
  Goal 3. Promote gender equality and empower women

Target 4. Eliminate gender disparity in primary and secondary education, preferably by 2005,
and to all levels of education no later than 2015

 Goal 4. Reduce child mortality

Target 5. Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

 Goal 5. Improve maternal health

Target 6. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

 Goal 6. Combat HIV/AIDS, malaria and other diseases

Target 7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS

Target 8. Have halted by 2015 and begun to reverse the incidence of malaria and other major
diseases

 Goal 7. Ensure environmental sustainability

Target 9. Integrate the principles of sustainable development into country policies and
programmes and reverse the loss of environmental resources

Target 10. Halve by 2015 the proportion of people without sustainable access to safe drinking
water

Target 11. By 2020 to have achieved a significant improvement in the lives of at least 100 million
slum dwellers

 Goal 8. Develop a global partnership for development

Target 15. Deal comprehensively with the debt problems of developing countries through
national and international measures in order to make debt sustainable in the long term

Target 16. In cooperation with developing countries, develop and implement strategies for
decent and productive work for youth

Target 18. In cooperation with the private sector, make available the benefits of new
technologies, especially information and communications
 Primary
Health Care
(PHC) in the
Philippines
 Introduction

Primary Health Care (PHC) is 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 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-determination.
Eight essential elements based on
the Alma Ata on PHC:

Treatment of Expanded
Maternal and Child
Health Education Locally Endemic Program on
Health
Diseases Immunization

Treatment of
Safe water and
Provision of communicable and
Nutrition good waste
Essential Drugs non-communicable
disposal
diseases
 GOAL OF PHC

The ultimate goal of primary

health care is better health for
all. WHO has identified five key
elements to achieving that goal:
 Five Key Elements to Achieve the Goal

1. Reducing exclusion and social disparities in

health (UNIVERSAL COVERAGE REFORMS);

2. Organizing health services around people’s

needs and expectations (SERVICE DELIVERY /
REFORMS);

3. Integrating health into all sectors

(PUBLIC POLICY REFORMS);

4. Pursuing collaborative models of policy

dialogue (LEADERSHIP REFORMS); and

5. Increasing stakeholder participation.

 History
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)

October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued
Letter of Instruction (LOI) 949 which mandated the then Ministry of Health to adopt PHC as an
approach towards design, development, and implementation of programs which focus health
development at the community level.
Adopting primary health care has
the following rationales:

4. Isolation
2.
of health
Inadequate
1. Magnitude 3. Increasing care
and unequal
of Health cost of activities
distribution
Problems medical care from other
of health
development
resources
activities
 Objectives of PHC
1. Improvement in
2. Favorable
the level of health
population growth
care of the
structure
community

3. Reduction in the 4. Reduction in

prevalence of morbidity and
preventable, mortality rates
communicable and especially among
other disease. infants and children.
 Objectives of PHC

5. Extension of essential
health services with 6. Improvement in basic
priority given to the sanitation
underserved sectors.

8. Maximizing the
7. Development of the contribution of the other
capability of the sectors for the social
community aimed at and economic
self- reliance. development of the
community.
 Types of PHC workers

There are two types of primary health care workers in

the Philippines:
1. Barangay Health Worker or Village
Health Worker
2. Intermediate level Primary Health
Worker
Four Pillars of PHC

Intra and
Active
Inter-
Community
sectoral
Participation
linkages

Support
Use of
mechanism
appropriate
made
technology
available
 Major Strategies

1. Elevating health to a 2. Promoting and

comprehensive and supporting community
sustained national effort managed health care

3. Increasing efficiency in 4. Advancing essential

health sector national health research
 Principles of PHC
Primary health care is run with the following principles:
1. 4 A’s = Accessibility, Availability, Affordability &
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.
 Principles of PHC
2. Community Participation
Barriers of Community Involvement
1. Lack of motivation
2. Attitude
3. Resistance to change
4. Dependence on the part of community people
5. Lack of managerial skills
 Principles of PHC
3. People are the center, object and
subject of development.
4. Self-reliance
5. Partnership between the community
and the health agencies in the provision
of quality of life.
 Principles of PHC

6. Recognition of interrelationship
between the health and
development
7. Social Mobilization
8. Decentralization
INTER-LOCAL HEALTH SYSTEM
 INTER-LOCAL
HEALTH SYSTEM
INTER-LOCAL HEALTH SYSTEM
➢Espoused by the DOH to ensure quality of
health care service at the local level
➢Individuals, communities and all other health
care providers in a well-defined geographical
area participate together in providing
equitable and accessible healthcare with
inter LGU partnership
INTER-LOCAL HEALTH ZONE (ILHZ)

Defined population

Number of primary level

facilities e.g. Rural Health Defined
Units (RHU) and Barangay geographical area
Health Station (BHS)

Central referral
hospital
 Expected Achievement of the Inter
Local Health System
Universal Improved quality
Effective referral Integrated
coverage of the of Hospital and
system planning
Health Insurance. RHU service

Appropriate Effective
Improved drug
health Developed leadership
management
information human resources through Inter-
system
system LGU cooperation

Financially Integration of Strengthened

visible /self- Public Health & cooperation
sustaining curative hospital between LGU and
hospitals care health sectors.
 Composition of the ILHZ
1. People – according to WHO the ideal health
district would have a population size between
100,000 and 500,000 for optimum efficiency and
effectiveness.
2. Boundaries – clear boundaries between ILHZ
determine the accountability / responsibility of
health service providers, geographical locations
and access to referral facilities.
3. Health facilities - district hospitals, RHU, BHS
 Composition of the ILHZ
4. Health workers that plan joint strategies for district health
care.
a. DOH
b. District Hospitals
c. Rural Health Units
d. Barangay Health Stations
e. Private Clinics
f. Volunteer Health Workers
g. Non-Government Organization
h. Community-based Organization
 LEVELS OF HEALTH CARE AND
REFERRAL SYSTEM

I. PRIMARY LEVEL OF CARE

➢devolved to cities and municipalities
➢Provided by center physicians, Public Health Nurses,
Rural Health Midwives, BHW, Traditional Healers
➢First contact between the community members
and other levels of health facility
II. SECONDARY LEVEL OF CARE
➢care given by physicians with basic health training
➢Given in health facilities wither privately owned or
government operated – district hospitals or out-patient
department of provincial hospitals
➢Referral center for primary health facilities
➢Capable of performing minor surgeries and
perform simple laboratory examinations
III. TERTIARY LEVEL OF CARE
➢Rendered by specialists in health facilities including
medical centers, regional and provincial hospital, and
specialized hospitals e.g. Philippine Heart Center
➢Referral center for the secondary care facilities.
➢Complicated cases and intensive care requires
tertiary care
LEVELS OF HEALTH CARE AND REFERRAL
SYSTEM
National Health
Services, Medical
Centers, Teaching and
Training Hospitals
Tertiary
Regional Health Services,
Regional Medical Centers &
Training Hospitals

Provincial / City Health Services

, Provincial / City Hospitals
Secondary

Emergency / District Hospitals

Rural Health Unit Community Hospitals and Primary

Health Centers, Private Practitioners

Barangay Health Stations

THE MILLENNIUM DEVELOPMENT GOALS

UN General Assembly decided to adopt a common

vision of poverty reduction and sustainable
development in September 2000.
This vision is exemplified by the Millennium
Development Goals (MDG’s) based on the fundamental
values of freedom, equality, solidarity, tolerance,
health, respect for nature and shared responsibility.
THE MILLENNIUM DEVELOPMENT GOALS

Eradicate Achieve Promote

extreme universal gender equality
poverty and primary and empower
hunger education women

Combat
Reduce child Improve HIV/AIDS,
mortality maternal health malaria and
other diseases

Develop a
Ensure
global
environmental
partnership for
sustainability
development
 HEALTH SECTOR REFORM
AGENDA
FOURmula One:
the framework for health sector reform as a means to
achieving the Millennium Development Goals
Goals:
FOURmula ONE for Health as Overall Frame

Better Health
Outcomes

Equitable More
Health Responsive
Care Health
Financing Systems
FOURmula ONE for Health:
Elements of the Strategy
Good
Governance -
Improved health
Health Service system
Delivery- Improve performance at
accessibility and the national and
Health availability of basic
Regulation- and essential
local levels
ensure quality & health care for all,
Health affordability of especially the poor.
Financing- goods and
greater, better services
& sustained
investment in
health