Friday, September 22, 2023
these facilities are capable of basic
NCM 104 - Community
Health Nursing
PRIMARY HEALTH CARE
- LEVELS OF HEALTH CARE
WORKERS
• 1. Village or Barangay Health Workers
- refers to trained community health
workers or health auxiliary volunteers
or traditional birth attendants or
healers.
- Initial Link: 1st contact of community
• 2. Intermediate Level Health Workers
- refers to general medical practitioners
or their assistants, public health
nurses, rural sanitary inspectors and
midwives.
- 1st source of professional health care
• First-line Hospital Workers
- Establish close contact with village +
intermediate level health workers.
- LEVELS OF HEALTH CARE
SERVICES
• PRIMARY: Cities + Municipalities
*health center sta
- devolved to the cities and
municipalities
and is the rst contact between the
community people and the di erent
levels of health facility, refers to health
care provided by the health center
sta .
- RHUs and Barangay Health Centers
• SECONDARY: District + Provincial
- rendered by the physicians with basic
health training in district hospitals,
provincial hospitals and city hospitals;
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surgical procedures and simple
laboratory examinations, serves as
the referral center
of primary facilities.
- Examples
• Bantayan District Hospital
• Regional Health Services
• District Health Services
• Rural (Local Hospital) Services
• TERTIARY: Specialists + Regional
Center
- rendered by specialists in medical
centers, regional hospitals and
specialized hospitals like the Lung
Center of the Philippines, serves as
the referral
center of secondary facilities.
- National Health Services
- Ex. Philippine Heart Center, National
Kidney and Transplant Institute, San
Lazaro Hospital, Philippine General
Hospital
- Two-Way Referral System
- Referral system
• Health problems that are beyond the
capability of the primary health care
units are referred to an intermediate
health facility like the Rural Health Unit
(RHU).
- The RHU team usually consists of:
- Rural Health Physician or
- Municipal Health O cer (MHO)
- Dentist
- Public Health Nurse (PHN)
- Rural Health Midwives (RHM)
- Sanitary Inspector
- BHWs or CVW
• Problems that are beyond the capability
of the RHU team are referred to the
District Hospital.
 - Clients manifesting more complicated
conditions need referral to higher
levels of care.
- Higher levels of health services at the
provincial, regional and national levels
provide secondary or tertiary care to
complete the health care given at the
district level.
• A Two-Way Referral System need to
be established between each level of
health facility e.g. barangay health
workers refer cases to the rural health
team, who in turn refer more serious
cases to either the district hospital, then
to the provincial, regional or the whole
health care system.
- 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 a ord
at every stage of development.
• The WHO de nes 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 a ord at
every stage of development.
- Conceptual Framework
• Health is a fundamental human right.
• Health is both an individual and
collective
responsibility.
• Health should be an equal opportunity
to all.
• Health is an essential element of socio-
economic development.
- Goal
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• The ultimate goal of primary health care
is better health for all
- Declared in Alma Ata, USSR
- 1ST international Conference on
PHC:
- September 6-12, 1978
- WHO + UNICEF
- In the Philippines: Letter of
Instruction (LOI 949)
• October 19, 1979
• Former President Ferdinand E.
Marcos
• Theme: Health in the Hands of the
People by 2020
• WHO has identi ed 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).
- Increasing stakeholder participation.
- As of HealthCare
• Accessible
• A ordable
• Acceptable
• Adequate
- Sustainable
- Community-based
- PHC as a service delivery policy of
the DOH permeates all strategies &
thrusts of Government health
programs
- National to Local & community levels
- PHC is a complete turn-about from
Disease- oriented + curative +
Hospital-based + urban- centered
health care To Preventive People-
 centered Community-based Health
Care
- CORNERSTONES OF PHC
• Four Pillars of PHC:
1. Use of appropriate technology
2. Support mechanism made
available
3. Active Community participation
4. Intra and Inter-sectoral linkages
• Appropriate Technology
- Implies the use of methods,
procedures, techniques, equipment,
- HEALTH PROMOTION
or materials that are not only
scienti cally sound but also provides
a socially and environmentally
acceptable service or product at the
least economic cost.
• Support Mechanism Made Available
- MULTISECTORAL APPROACH:
Recognizes intersectoral and
intrasectoral linkages in health. With
intersectoral linkages PHC recognizes
the integration of health plans with
other sectors for total community
development.
- Sectors most closely related to health
include:
• Local governments o Education
• Agriculture
• Public Works
• Population control
• Social welfare
• Active Community Participation
• Intra and Inter-sectoral Linkag
- Intrasectoral Linkages: Deals with
establishing a close working
relationship of the personnel within
and between the di erent levels
(primary, secondary, tertiary level) of
health care services. Administration,
logistic and technological support will
be ensured through this.
- Elements of PHC
• HC Element
- Health Education
- CD Control
- EPI
- Locally Endemic Disease Treatment
- Environmental Sanitation
- Maternal & Child Health + Family
Planning
- Essential Drugs
- Nutrition
- Treatment of Emergency Cases
• Directed towards Healthy Individuals or
Populations
• Focus: Prevention of emergence of risk
factors
- unhealthy lifestyle behavior
• Individuals and Family
- Awareness: importance of healthy
lifestyle
- Education: maintenance
- Giving SUPPORT = Sustain CHANGE
- INDIVIDUALS: Deals with increasing
the awareness of the individual on the
importance of a healthy lifestyle,
providing education in its
maintenance, and giving support for
him/her to sustain change of behavior
towards healthy lifestyle and good
personal habits.
- FAMILY: Deals with soliciting support
from the family for lifestyle changes in
the individual member by changing
their beliefs and practices as well.
• Community
- Deals with making healthy lifestyle
behavior a norm in the community.
- Healthy Lifestyle = NORM
• Soceity
- A healthy society makes sure that the
basic needs of the citizens are met,
the dignity and rights of the citizens
are upheld and protected, the talents

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 and kills of its citizens are utilized for • Tertiary Level Disease Prevention
development. - Directed towards individuals in the
- Basic needs are met pathogenic stage of the disease;
- Dignity + Rights = upheld + protected deals with the reduction of the
- Talents + Skills = utilized magnitude and severity of the residual
• Environment e ects of communicable disease and
- Deals with the promotion of proper non-communicable diseases
environmental sanitation and then - Ex: Rehabilitation of a post-stroke
reduction of pollution. patient, Control of spread of measles
- Proper Sanitation (epidemic)
- Reduction of Pollution - Pathogenic stage
- Nutrition - Reduction of residual e ects (severity)
- Exercise
- Vector Control
- Water Supply
- Waste Disposal

- LEVELS OF DISEASE PREVENTION

• Primary Level Disease Prevention
- Directed towards individuals who are
at risk of developing a disease or
those who are in the pre-pathogenic
stage; deals with the removal of risk
factors of speci c protection of
individuals against these risk factors.
- At risk or Pre-pathogenic stage
- Removal of risk factors
- Speci c protection
- Ex: Immunization, Food
Supplementation, Malaria
Chemoprophylaxis
• Secondary Level Disease Prevention
- Directed towards individuals in the
subclinical stage, asymptomatic and
symptomatic stage of a disease, aims
to diagnose and treat existing health
problems at the earliest possible time
and to limit disabilities attributed to it.
- Ex: Screening, case nding,
surveillance and treatment of
communicable disease.
- Subclinical stage + ASX
- Early diagnosis + Treatment
- Limits disabilities

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 FOURMULA ONE PLUS
(4MULA 1+)
- With the aim of attaining the goals outlined
in the Philippine Development Plan 2017-
2022 and the Sustainable Development
Goals, building on the concept of
Fourmula One for Health 2005 to 2010, the
medium- term strategic framework for
2017 to 2022 expands the four pillars of
health reforms and highlights greater focus
on performance accountability towards the
Filipino people, thus, Fourmula One Plus
for Health or F1+, with its tagline
“Boosting Universal Health Care”.
- Current Secretary of Health: Dr. Teodoro
Herosa (2023)
- Objectives of Fourmula One Plus
• This Administrative Order aims to:
- Provide the overall policy directions
for DOH o ces, its attached
agencies, and local government units
in terms of prioritizing activities
related to the FOURmula One Plus for
Health 2017- 2022.
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- Provide guidance to development
partners, other government agencies,
and private stakeholders in identifying
priority areas for health services and
support.
- General Guidelines
• 4mula 1+ for Health shall organize
critical initiatives in health into four
strategic pillars, namely: Financing,
Regulation, Service Delivery,
Governance, plus a cross cutting
initiative on Performance
Accountability.
• The implementation of 4mula 1+ for
Health shall focus on sustainable,
manageable, and critical interventions
that optimize available resources,
supported by evidence and su cient
groundwork, and produce tangible
results that are felt by Filipinos.
• The reforms shall be implemented under
the concept of a whole (society,
government, and system) approach that
encompasses the entire health sector
and other social determinants impacting
health.
• The Functional management
arrangements shall be de ned in terms
of speci c o ces and institutions
having clear mandates, performance
targets, and support systems, Within
well-de ned time frames in the
implementation of reforms within each
pillar.
- Policy Framework
• Vision
- The DOH envisions Filipinos as
among the healthiest people in
Southeast Asia by 2022, and in Asia
by 2040.
• Mission
- The DOH shall lead the country in the
development of a productive,
 resilient, equitable, and
peoplecentered health care system.
• Core Values
- The DOH shall embody at all times
integrity, excellence, professionalism,
responsiveness, and compassion in
carrying out its tasks and
responsibilities.
• Goals
- The 4mula 1+ for Health aims to
ensure better health outcomes, a
more responsive health system, and a
more equitable health care nancing.
• Strategic Pillars
- The DOH shall organize health sector
initiatives into four (4) pillars, namely:
Financing, Service Delivery,
Regulation, Governance, plus a
cross-cutting initiative on
Performance Accountability.
- STRATEGIC PILLAR 1: HEALTH
FINANCING
• Objective
- Secure sustainable investments to
improve health outcomes and ensure
e cient and equitable use of health
resources.
• Interventions:
1. E ciently mobilize and equitably
distribute more resources for
health.
2. Rationalize health spending.
3. Focus nancial resources towards
high
impact interventions.
- STRATEGIC PILLAR 2: HEALTH
SERVICE DELIVERY
- Objective:
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• Ensure the accessibility of essential
quality health products and services at
appropriate levels of care.
- Interventions:
1. Increase access to quality essential
health products and services.
2. Ensure equitable access to quality
health facilities
3. Ensure equitable distribution of
human resources for health.
4. Engage Service Delivery Networks to
deliver comprehensive package of
health services.
- STRATEGIC PILLAR 3: HEALTH
REGULATION
- Objective:
• Ensure high quality and a ordable
health products, devices, facilities, and
services
- Interventions:
1. Harmonize and streamline regulatory
systems and processes.
2. Develop innovative regulatory
mechanisms for equitable distribution
of quality such as adopting a network
licensing and network accreditation
of health facilities
- STRATEGIC PILLAR 4: GOOD
GOVERNANCES
- Objective:
• Strengthen leadership and management
capacities coordination, and support
mechanism necessary to ensure
functional, people-centered and
participatory health systems.
- Interventions:
1. Strengthen sectoral leadership and
management
2. Improve organizational development
and performance
 3. Ensure evidence-based decision
making and health policy
development

- STRATEGIC PILLAR “PLUS”:

PERFORMANCE ACCOUNTABILIT
- Objective:
• Use the performance management
systems to drive better execution of
policies and programs in the DOH while
ensuring responsibility to all
stakeholders.
- Interventions:
1. Institute transparency and
accountability measures
2. Shift to outcome-based management
approach

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 UNIVERSAL HEALTH CARE
- UNIVERSAL HEALTH CARE ACT
(R.A. 11223)
• UHC means all Filipinos are guaranteed
equitable access to quality and
a ordable health care goods and
services, and protected against nancial
risk.
• Former President Duterte signed R.A.
11223 or the Universal Health Care Act
into law last February 20, 2019.
• The UHC Act contains comprehensive
and progressive reforms that will ensure
every Filipino is healthy, protected from
health hazards and risks, and has
access to a ordable, quality, and readily
available health service that is suitable
to their needs.
• Sa UHC lahat...
- Makikinabang
- Protektado
- Naaalagaan
- Konektado
- Kasama
- GENERAL ASPECTS OF UHC ACT
• Who will bene t from the UHC Act?
- All Filipinos will bene t from the UHC
Act. The government will ensure that
the wellbeing and health needs of all
Filipinos, especially those of the
vulnerable population, will be
addressed.
• How will the UHC Act ensure that
every Filipino has access to quality
and a ordable health care?
- Every Filipino should be able to
access preventive, promotive,
curative, rehabilitative, and palliative
health services.
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- The UHC Act will improve and
strengthen existing health sector
processes and systems by
highlighting primary care close to
families and communities, supported
by hospitals that are contracted as
part of a network, and making
PhilHealth membership automatic for
every Filipino.
- This will eventually lead to the
establishment of better networks of
providers and facilities, making health
accessible for all.
• Will all health services be free
through UHC?
- One of the goals of the UHC Act is to
decrease the out-of-pocket expenses
of families. This means that some
health services may become more
a ordable, but not everything will be
free. At the very least, the prices of
health goods and services will be
predictable and a ordable.
- Depending on the available budget,
such as additional revenue from
tobacco, alcohol, and sugar-
sweetened beverage taxes, and the
value-based decisions of health
technology assessment, DOH and
PhilHealth will design bene ts for this.
• What do you mean by a primary care-
focused health system?
- In a primary care-focused health
system, the frontline of health
services will be strengthened so that
every Filipino will have a trusted
primary care provider. The primary
care provider will be the initial and
continuing point-of-contact of
patients/clients with the health
system. The health care sta will
provide the needed basic health
services.
 - If higher-level health services are
needed, the primary care provider will
navigate patients/clients to a health
care provider that can give the
appropriate care. By providing clinical
leadership and guidance, hospitals
may in uence the design of these
primary care services while allowing
them to focus on more complicated
cases.
- A. FINANCING
• Are all Filipinos members of
PhilHealth? Do families still need to
register/enlist with PhilHealth?
- All Filipinos are now members of
PhilHealth. Families who are not yet
registered/enlisted with PhilHealth will
be assisted by their health care
provider with the next steps.
• Is the PhilHealth ID required in
availing bene ts?
- No. A PhilHealth identi cation card is
not required to avail of any health
services.
• Do we need to pay contributions to
PhilHealth?
- Under the UHC Act, Direct
Contributors are those who have the
capacity to pay premiums, such as
employees, self- earning, professional
practitioners, migrant workers,
including their quali ed dependents,
and lifetime members. They will have
to pay PhilHealth contributions.
- All others not mentioned above are
considered as Indirect Contributors.
They include indigents identi ed by
the DSWD, bene ciaries of the
Conditional Cash Transfer Program,
and those identi ed in special groups,
such as senior citizens, persons with
disabilities, and Sangguniang
Kabataan (SK) o cers. Their monthly
payment in PhilHealth are covered by
the national government.
• What will happen if a direct
contributor fails to pay monthly
premium to PhilHealth?
- A direct contributor who failed to pay
premiums can still avail of PhilHealth.
However, he/she will have to pay
missed contributions with an interest
compounded monthly. The interest
penalty for employers will not be less
than 3%; the interest penalty for self-
earning, professional practitioners
and migrant workers will not be less
than 1.5%.
• Will the PhilHealth premium
contribution increase?
- Over the next ve years, PhilHealth
will
gradually increase premium rates for
direct contributors, while providing
corresponding increase in bene ts.
- Direct contributors will have to pay
the premium according to the
following rates:
• What is the role of private sector
nancing agents in nancing health
services under the UHC Act?
- Under the Act, private sector
nancing agents such as HMOs and
private health insurance will o er
complementary (o ering bene ts
that cover services or diagnostic-
groups that PhilHealth is unable to) or
supplementary (o ering bene ts that
pay for shares of the hospital bill that

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 PhilHealth is unable to) bene t
packages to patients.
• What are the sources of funds for
health nancing under the UHC Act?
- Here are the fund sources that can
be tapped to nance the
implementation of the UHC Act:
• Increasing revenues from tobacco,
alcohol,
sugar-sweetened beverages taxes
• Funds from Philippine Charity
Sweepstakes O ce (PCSO),
Philippine Amusement and Gaming
Corporation (PAGCOR), and
Department of Health
Medical Assistance
• DOH Health Programs
• Annual appropriations of the DOH
• Proposed increased premium rates
and collection e ciency in
PhilHealth
- B. SERVICE DELIVERY AND LOCAL
HEALTH SYSTEMS
- How will the UHC Act assure better
service delivery especially in hard-to-
reach areas?
• Under the UHC Act, the government
will
prioritize investments on health
services, infrastructures, and human
resources in hard-to-reach areas.
• The list of the hard-to-reach areas will
be annually updated as this will become
the basis for preferential licensing of
health facilities and contracting of health
services.
- What does “essential health bene t
package” mean?
• Essential health bene t package
refers to a set of individual-based
entitlements covered by the PhilHealth
which includes primary care; medicines,
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diagnostic and laboratory; and
promotive, preventive, curative, and
rehabilitative services
- As a current patient of a specialist, am I
required to go to a primary care
provider?
• You may still retain your specialist
doctor, but after he/she is able to treat
you, you must be referred back to a
primary care provider. A specialist can
be certi ed as a primary care provider
provided that he/she must receive a
certi cation in primary care as
determined by the Department of
Health.
- Are government physicians
automatically considered as primary
care providers?
• Government physicians can be certi ed
primary care providers. The DOH will
prepare a mechanism to recognize and
certify the abilities of government
physicians to deliver primary care.
- How will health promotion and
preventive services be prioritized?
• The schools under the supervision of
the Department of Education (DepEd)
shall formulate programs and modules
on health literacy and rights to be
integrated into the existing school
curricula.
• This will intensify the ght against the
spread of communicable diseases and
increase in prevalence of
noncommunicable diseases through
the e ective promotion of healthy
lifestyle among students, including but
not limited to, physical activity, proper
nutrition, and prevention of smoking
and alcohol consumption.
 - C. HUMAN RESOURCES FOR
HEALTH
• How will the UHC Act comprehensively
address issues of Human Resources for
Health?
- The following mechanisms will ensure
that there will be enough human
resources in the di erent levels of the
health sector:
• National Health Resource Master
Plan
• National Health Workforce Support
System
• Scholarship and Training Program
• Return Service Agreement
• Will doctors, nurses, midwives and
others under the DOH Deployment
Program be hired under “plantilla”
(regular employee) position?
- Under the UHC Act, all health
professionals and health care workers
will be guaranteed permanent
employment and competitive salaries.
- Mechanisms and processes of this
provision are being discussed with
the Department of Budget and
Management in so far as public
sector health workers are concerned.
- D. REGULATION
• Will there be reductions in the types
of bene ts that are currently being
given by PhilHealth?
- There will be no reductions in the
currently
implemented bene t packages under
PhilHealth. However, under the UHC
Act, the bene t development process
will now undergo Health Technology
Assessment to ensure that
interventions funded by PhilHealth are
cost-e ective.
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• What is the purpose of accreditation
under the UHC Act?
- Accreditation will follow a rating
system to acknowledge better service
quality, e ciency and equity.
- PhilHealth shall recognize third party
accreditation mechanisms and may
use these as basis for granting
incentives. This is di erent from
contracting which is a function of
service delivery.
• Does the UHC Act set maximum retail
prices for drugs sold to the public?
- Under the UHC Act, DOH is
mandated to prescribe mark-ups on
drugs and medical devices sold in
DOH owned healthcare facilities.
However, PHIC may also use the
mark-ups prescribed by the DOH for
other health facilities it contracts,
whether public or private.
• Are pharmacies or drug outlets
required to have generic medicines
available at all times?
- Yes. All drugs are required to carry
and o er to the public generic drug
equivalent of all drugs in accordance
to the existing laws: the Generics Act
of 1988 and the Cheaper Medicines
Act of 2008.
- Under the UHC act, this was further
strengthened, mandating drug outlets
to carry generics, particularly fair
priced unbranded generics for all
drugs addressing the common
diseases in the community as
contained in the Primary Care
Formulary.
 - E. GOVERNANCE
• Why should health promotion be
mainstreamed?
- We always say that an ounce of
prevention is better than a pound of
cure. In practical terms, the cost of
instituting health promotion and
prevention is less than the cost of
paying for treatment and
hospitalization.
- There are several health interventions
that can be done at the level of
families and communities, even
before the patient contacts the health
system.
- Health promotion will empower and
capacitate Filipinos on how to take
charge of their own health.
• What does UHC Act provide in terms
of health information systems?
- Health service providers and insurers
are mandated to maintain a health
information system consisting of
enterprise resource planning, human
resource information, electronic
health records, and electronic
prescription log subject to relevant
provisions of Data Privacy Act of
2012 .
• What is Health Technology
Assessment (HTA)?
- Health Technology Assessment
(HTA) refers to the systematic
evaluation of health interventions
developed to solve a health problem
and improve quality of lives and
health outcomes. It uses a
multidisciplinary process to evaluate
the social, economic, organizational
and ethical issues of a health
intervention or health technology
• Why does the health system need
HTA?
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- With the growing demand for health
care and the limited resources,
priority setting is crucial in the health
system.
- HTA will serve as the primary tool in
ensuring that health services and
goods provided by the government
are cost e ective.
• What is the scope of HTA?
- HTA will cover drugs, vaccines,
medical devices, medical equipment,
medical and surgical procedures,
preventive, and promotive health
services, traditional medicine and
other health-related interventions that
are seeking coverage or funding in
the public sectors.
• Will HTA determine health conditions
to be covered?
- HTA will not determine conditions to
be covered but it will identify
interventions that are cost-e ective
for each condition.
• Will the HTA results be
recommendatory or binding?
- HTA results and evidence generated
by the researchers are appraised and
used by the expert advisory councils
to make their recommendations to
the Secretary of Health.
- Only health technologies with a
positive recommendation by the HTA
council will be adopted by DOH and
PhilHealth.
• What is health impact assessment
(HIA)?
- Health Impact Assessment (HIA) will
evaluate policies, programs, and
projects that are crucial in attaining
better health outcomes or those that
may have an impact on the health
sector. It is di erent from HTA.