COMMUNITY HEALTH NURSING 120

OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

A. Global & National Health Situations
1. Infectious diseases
2. Maternal & child health
3. NCDs
4. Health disparities
5. Disaster preparedness & response
6. Health promotion & education
7. Universal healthcare

B. DEFINITION & FOCUS:

HEALTH - (WHO, 1958) is a state of complete physical, mental & social well-being & not merely the
absence of disease or infirmity.
 DETERMINANTS OF HEALTH:
a. Income & social status
b. Education
c. Physical environment
d. Employment & working conditions
e. Social support networks
f. Culture
g. Genetics
h. Personal behavior & coping skills
i. Health services
j. Gender

PUBLIC HEALTH - (Dr. C. E. Winslow) is the science & art of preventing disease, prolonging life, &
promoting physical health & efficiency through organized community efforts for the sanitation of the
environment, control of communicable diseases, the education of individuals in personal hygiene, the
organization of medical & nursing services for the early diagnosis & preventive treatment of disease, &
the development of social machinery to ensure everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of
health & longevity.

COMMUNITY – (WHO Expert committee, 1974) is a social group determined by geographical boundaries
&/ or common values & interest. Its member know & interact with each other. It functions within a
particular structure & exhibits & creates certain norms, values & social institutions.

COMMUNITY HEALTH – (WHO, 1971) refers to the health status of the members of the community, to the
problems affecting their health & to the totality of health care provided to the community.

PUBLIC HEALTH NURSING – (Freeman, 1963 ) defined as a field of professional practice in nursing & in
public health in which technical nursing, interpersonal, analytical & organization skills are applied to
problems of health as they affect the community.

1
 COMMUNITY HEALTH NURSING – (ANA, 1980 ) is the synthesis of nursing practice & public health to
promote & preserve the health of populations. Care is directed to individuals, families, & groups.
Contributes to the health of the total population.

CHN – (Bailon-Reyes) is a field of nursing practice where services are delivered outside of purely curative
institutions (i.e. hospitals), but in community settings such as the home, the school, places of work, health
centers & clinics.

PHN/ CHN – (WHO Expert Committee of Nursing) as a special field of nursing that combines the skills of
nursing, public health & some phases of social assistance & functions as part of the total public health
programme for the promotion of health, the improvement of the conditions in the social & physical
environment, rehabilitation of illness & disability.

COMMUNITY-BASED NURSING – (McEwen & Pullis, 2009) Application of the nursing process in caring for
individuals, families & groups where they live, work or go to school or as they move through the health
care system. Setting-specific. Emphasis is on acute & chronic care.

POPULATION-FOCUSED NURSING – (Minnesota DOH, 2003) Focuses on the entire population. Is based on
the assessment of the population’s health status. Considers the broad determinants of health. Emphasizes
all levels of prevention. Intervenes with communities, systems, individuals, & families.

 STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

a. Theory
b. Data Collection
c. Diagnosis
d. Planning
e. Intervention
f. Evaluation
g. Quality Assurance and Professional Development
h. Interdisciplinary Collaboration
i. Research

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

1912 - Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of present MHOs; male
nurses perform the functions of doctors

1914 - School nursing was rendered by a nurse; Act #2462 Office of General Inspection was created
headed by Dr. Rosario Pastor, a lady physician & a nurse

1916-1918 - Miss Perlita Clark took charge of the public health nursing work

1919 - Act # 2808 (Nurses Law was created) – Carmen del Rosario, 1st Filipino Nurse supervisor under
Bureau of Health

Oct. 22, 1922 - Filipino Nurses Organization (Philippine Nurses’ Organization) was organized.

1923 - Zamboanga General Hospital School of Nursing & Baguio General Hospital were established;
other government schools of nursing were organized several years after.

1928 - 1st Nursing convention was held

2
1940 - Manila Health Department was created.

1941 - Dr. Mariano Icasiano became the first city health officer; Office of Nursing was created through
the effort of Vicenta Ponce (chief nurse) and Rosario Ordiz (assistant chief nurse)

Dec. 8, 1941 - Victims of World War II were treated by the nurses of Manila.

July 1942 - Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31 Filipino nurses in
Bilibid Prison as prisoners of war by the Japanese.

Feb. 1946 - Number of nurses decreased from 556 to 308.

1948 - First training center of the Bureau of Health was organized by the Pasay City Health Department.
Dr. Trinidad Gomez, Marcela Gabatin, Contancia Tuazon, Mrs. Bugarin, Ms. Ramos, and Zenaida Panlilio
composed the training staff.

1950 - Rural Health Demonstration and Training Center was created.

1953 - RA 1082 or Rural Health Law was approved; created the first 81 Rural Health Units

1957 - RA 1891 amended some sections of RA 1082 and created the eight categories of rural health unit
causing an increase in the demand for the community health personnel.

1958-1965 - Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288)

1961 - Annie Sand organized the National League of Nurses of DOH.

1967 - Zenaida Panlilio-Nisce became the Nursing Program Supervisor and consultant on the six special
diseases (TB, Leprosy, V.D., Cancer, Filariasis, and Mental Health illness).

1975 - Scope of responsibility of nurses and midwives became wider due to restructuring of the health
care delivery system.

1976-1986 - The need for Rural Health Practice Program was implemented.

1990- 1992 - The number of positions of Nursing Program supervisors (Nurse VI) was increased as there
were three or more appointed in each service.

1993-1998 - Office of Nursing did not materialize in spite of persistent recommendation of the officers,
board members, and advisers of the National League of Nurses Inc.

Jan. 1999 - Nelia Hizon was positioned as the Nursing Adviser at the Office of Public Health Services
through Department order # 29.

May 24, 1999 - EO # 102, which redirects the functions and operations of DOH, was signed by former
President Joseph Estrada.

Feb. 20, 2019 - Duterte signed into law the UHC or Republic Act No. 11223

3
 ROLES OF A CHN:
1. Advocate – seeks to promote an understanding of health problems; looks for beneficial
public policy & stimulates the emergence of a supportive community action for health.
2. Care manager – clients need help in making decisions about appropriate health care
services. Achieving service delivery integration & coordination is a major task of the CHN.
3. Case finder – looks for clients at risk among the population served.
4. Counselor – clients in the community health setting frequently face difficult & complex
health concerns & desire supportive & problem solving assistance. They deal with stree
related to health concerns.
5. Clinic nurse – clinic services are increasingly expanding to meet the needs of aggregates at
risks.
6. Epidemiologist – uses the epidemiological method to study the disease & health among
various population groups & to deal with community-wide health problems.
7. Group leader – works in groups in practice.
8. Health planner – provides health programs for the community
9. Home visitor – enters the clients’ setting. He/ She assesses the environment & works within
it. He/ She also gathers information about how a family system functions within its own
setting. The CHN also provides direct care services with clients.
10. Occupational health nurse – also concerned with risks & problems in the work environment
of the people.
11. Researcher – assists health care professionals in reaching their goals through research.
12. School nurse – works with students in school.
13. Teacher – facilitates change in behavior among clients which is a basic intervention strategy
in community health.

 RESPONSIBILITIES OF A CHN:
1. Be a part in developing an overall health plan, its implementation and evaluation for
communities
2. Provide quality nursing services to the three levels of clientele
3. Maintain coordination/linkages with other health team members, NGO/government
agencies in the provision of public health services
4. Conduct researches relevant to CHN services to improve provision of health care
5. Provide opportunities for professional growth and continuing education for staff
development

4
  HEALTH CARE DELIVERY SYSTEM – (Williams-Tungpalan, 1981) the network of health
facilities & personnel which carries out the task of rendering health care to the people.

A. WORLD HEALTH ORGANIZATION (WHO) - the directing and coordinating authority in global
public health within the United Nations system. Their goal is to ensure that a billion more
people have universal health coverage, to protect a billion more people from health
emergencies, and provide a further billion people with better health and well-being.
1. Millenium Development Goals - are eight goals that all 191 UN member states have agreed
to try to achieve by the year 2015.
1) To eradicate extreme poverty and hunger
2) To achieve universal primary education
3) To promote gender equality and empower women
4) To reduce child mortality
5) To improve maternal health
6) To combat HIV/AIDS, malaria, and other diseases
7) To ensure environmental sustainability
8) To develop a global partnership for development.

2. Sustainable Development Goals - also known as the Global Goals, were adopted by all
United Nations Member States in 2015 as a universal call to action to end poverty, protect the
planet and ensure that all people enjoy peace and prosperity by 2030. The aim is for all
countries to work together to ensure no one is left behind.
1. No poverty

2. Zero hunger

3. Good health & wellness

5
4. Quality education

5. Gender equality
6. Clean water & sanitation

7. Affordable & clean energy

8. Decent work & economic growth

9. Industry, innovation & infrastructure

10. Reduced inequalities

11. Sustainable cities & communities

12. Responsible consumption & reduction

13. Climate action

14. Life below water

15. Life on land

16. Peace, justice, & strong institutions

17. Partnerships for the goals

B. PHILIPPINE DEPARTMENT OF HEALTH - Is the principal health agency in the Philippines.

It is responsible for ensuring access to basic public health services to all Filipinos through the
provision of quality health care & regulation of providers of health goods & services.

Mission: To lead the country in the development of a productive, resilient, equitable & people-
centered health system.

Vision: Filipinos are among the healthiest people in Southeast Asia by 2022, & Asia by 2040

 Historical background:

June 23, 1898 – creation of the Department of Public Works, Education, & Hygiene thru
President Aguinaldo

Jan. 1, 1941 – creation of the Department of Health & Public Welfare

1958 – creation of 8 regional health offices & 2 Undersecretaries of Health

6
1972 – DOH was renamed Ministry of Health

1986 – Ministry of Health became Department of Health again.

2006 – The PAGC recognized & awarded the DOH as the number one government agency in
fighting corruption.

 Local health system & devolution of health services

 Classification of health facilities (DOH AO-0012A): "Rules and Regulations

Governing the New Classification of Hospitals and Other Health Facilities in the
Philippines"

 Philippine health agenda 2016-2022: "All for health towards health for all"
Goals: Financial risk protection; Better health outcomes; and Responsiveness
Values: Equity, Efficiency, Quality & Transparency
A- Advance quality, health promotion and primary care
C- Cover all Filipinos against health-related financial risk
H- Harness the power of strategic HRH development
I- Invest in eHealth and data for decision-making
E- Enforce standards, accountability and transparency
V- Value all clients and patients, especially the poor, marginalized, and vulnerable
E- Elicit multi-sectoral and multi-stakeholder support for health

7
C. PRIMARY HEALTH CARE (PHC) – (WHO) is essential care made universally accessible to
individuals & families in the community by means acceptable to them through their full
participation & at a cost that the community & country can afford at every stage of
development.
- The concept of PHC is characterized by partnership & empowerment of the people that shall
permeate as the core strategy in the effective provision of health services that are
community based, accessible, acceptable, & sustainable at a cost which the community
& the government can afford.

 Brief 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.

 Legal Basis:
- Letter of Instruction (LOI) 949 signed on October 19, 1979 by then President Ferdinand
E. Marcos – one year after the first International Conference on Primary Health Care was
held in Alma Ata, USSR on September 6-12, 1978, sponsored by the World Health
Organization & UNICEF.

 Goals: “Health for all Filipinos and Health in the Hands in the People by the year 2020.”

 Elements/ Components:
E – Education for Health
L – Locally endemic disease control
E – Expanded program for immunization
M – Maternal and Child Health including responsible parenthood
E – Essential drugs
N – Nutrition
T – Treatment of communicable and non-communicable diseases
S - Safe water and sanitation

8
 Principles & Strategies:
1. Accessibility, Availability, Affordability and Acceptability of Health Services
 Health services delivered where the people are
 Use of indigenous/resident volunteer health worker as a health care provider
with a ratio of one community health worker per 10-20 households
 Use of traditional (herbal medicine) with essential drugs.
2. Provision of quality, basic and essential health services
 Training design and curriculum based on community needs and priorities.
 Attitudes, knowledge and skills developed are on promotive, preventive, curative
and rehabilitative health care.
 Regular monitoring and periodic evaluation of community health workers
performance by the community and health staff.
3. Community Participation
 Awareness, building and consciousness raising on health and health-related
issues.
 Planning, implementation, monitoring and evaluation done through small group
meetings (10-20 households cluster)
 Selection of community health workers by the community.
 Formation of health committees.
 Establishment of a community health organization at the parish or municipal
level.
 Mass health campaigns and mobilization to combat health problems.
4. Self-reliance
 Community generates support (cash, labor) for health programs.
 Use of local resources (human, financial, material)
 Training of community in leadership and management skills.
 Incorporation of income generating projects, cooperatives and small scale
industries.
5. Recognition of interrelationship of health and development
 Convergence of health, food, nutrition, water, sanitation and population
services.
 Integration of PHC into national, regional, provincial, municipal and barangay
development plans.
 Coordination of activities with economic planning, education, agriculture,
industry, housing, public works, communication and social services.
 Establishment of an effective health referral system
6. Social Mobilization
 Establishment of an effective health referral system.
 Multi-sectoral and interdisciplinary linkage.
 Information, education, communication support using multi-media.
 Collaboration between government and non-governmental organizations.

9
 7. Decentralization
 Reallocation of budgetary resources.
 Reorientation of health professional and PHC.
 Advocacy for political and support from the national leadership down to the
barangay level.

D. LEVELS OF PREVENTION:
1. Primary Prevention – prevention of problems before they occur, example: immunization. It
consists of two elements:
a) general health promotion – efforts enhance resiliency & protective factors & target
essentially well populations.
b) specific protection – efforts reduce or eliminate risk factors & include such measures as seat
belt use
2. Secondary Prevention – refers to early detection & intervention, example: screening for STD
3. Tertiary Prevention – correction & prevention of deterioration of a disease state, example:
teaching insulin administration in the home

E. UNIVERSAL HEALTH CARE (UHC) – also referred to as Kalusugan Pangkalahatan (KP) is the
“provision to every Filipino of the highest possible quality of health care that is
accessible, efficient, equitably distributed, adequately funded, fairly financed, &
loappropriately used by an informed & empowered public.”

 Legal Basis:
REPUBLIC ACT No. 11223 - An Act Instituting Universal Health Care for All Filipinos,
Prescribing Reforms in the Health Care System, and Appropriating Funds Therefore
Section 1. Short Title. - This Act shall be known as the "Universal Health Care Act".
Section 2. Declaration of Principles and Policies. - It is the policy of the State to protect
and promote the right to health of all Filipinos and instill health consciousness among
them.

 Background & Rationale:

 Objective

 Thrusts:
1. Financial risk protection through expansion in NHIP enrollment and benefit
delivery - the poor are to be protected from the financial impacts of health care
use by improving the benefit delivery ratio of the NHIP.
2. Improved access to quality hospitals and health care facilities – government
owned and operated hospitals and health facilities will be upgraded to expand
capacity and provide quality services to help attain MDGs, attend to traumatic

10
 injuries and other types of emergencies, and manage non-communicable
diseases and their complications/
3. Attainment of the health-related MDGs - public health programs shall be
focused on reducing maternal and child mortality, morbidity and mortality from
TB and malaria, and the prevalence of HIV/AIDS, in addition to being prepared
for emerging disease trends, and prevention and control of non-communicable
diseases.

11