PRIMARY HEALTH CARE 1
Levels of Prevention
Primary
 Healthy
 Promotion of health
 Achieve the highest level of wellness
Nutrition, exercise, rest.
 Prevention of illness - Identify the
different risk factors Specific disease.
 Immunization/vaccination
Secondary
 Sick = restore health, cure,
 Early detection = early treatment;
limit the disease process, to shorten
illness, to prevent complication
 Identify the early signs and
symptoms
 Test--- ID presences restore health,
cure.
Tertiary
 recovered= remnant of diseases
( optimum level of functioning.
 Level clientele: Individual, Family,
Community.
Health Care Delivery System
— Health care system is an organized plan
of health services. === Job the DOH
— 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
( Primary) hospitals
 B(Basic)EMONC= Lying-in
 Suction machine, Oxygen
Secondary
 District hospitals ( Inter- Local Health
Zone), Provincial hospitals
 C(comprehensive)EMONC= District
hospitals Provincial
 C/S. Blood Transfusion
Tertiary
 Regional Hospitals, PGH, specialized
hospitals.
 Ex. Lung center, Heart center
Levels of Health Care Workers
Primary
 Midwifes --- first health professional
- deals the clients
Secondary
 Nurses
Tertiary
 Doctor
 X-ray Technician, Medical
Technologists= back ups in
the diagnosis
 Nutritionist, Pharmacists =
Back ups in the giving of
direct nursing care to the
patients
RHCDS===== 2 -way referral system
HEALTH TEAM
RHP — 1:20000
PHN, RSI, BNS — 1: 20000
RHDentist — 1:50,000
RHM — first health professional
1Mw : 5000 population
BHW — 1:20 households
RHU STAFF AND ORGANIZATION
 RHP (Rural Health Program)
 MHO (Municipality Health Officer)-
1-2
 RHD (Rural Health Dentist) – 1
 PHN (Public Health Nurse) – 1-2
 RMT (Rural Medical Technology) – 1
 RHM (Rural Health Midwife) - 5 or
more
 RSI (Rural Health Sanitary) 1-2
 Dental Aid - 1
 Ambulance Driver – 1
— 1-3 RHMs in RHU & 1 RHM for every
BHS (Baranggay Health Station) –
assisted by BHWs in health services.
Facilities
 Management Information Systems
regulated by R.A 3753: Vital Health
Statistics Law.
 Primary Health Care (PHC) regulated
by LOI 949 (1984): Legislation of
Implementation of PHC in the
Philippines.
Restructured Health care Delivery System
 2- way Referral system
 Inter Local Health
 Zone Devolution
LOCAL HEALTH BOARD
= Municipal Level
● Mayor — chairman
● Rural Health Physician — C0-chairman
= Provincial Level
● Governor — chairman
● Provincial Health Officer

BHS (Baranggay Health Station) — 1:5000 DOH

RHU (Rural Health Unit) — 1:20,000 — Regional, PGH, Specialized
currently 1:40,000
Emergency Hospital —10-15 beds The DOH has three major roles in the health
BEMONC Facility — 1: 145,000 population sector:
District Hospitals Level 2 — 90-150 beds
Provincial Hospitals  leadership in health;
Regional Hospitals Level 3 — 200-1500 beds  enabler and capacity builder; and
Central Referral — PGH  administrator of specific services.
Specialized Hospital
Leading causes of Morbidity ( sickness) &
Mortality (deaths) Before pandemic
THREE STRATEGIES IN DELIVERING HEALTH covid19.
SERVICES (ELEMENTS)
 Heart
 Creation of Restructured Health Care  Ds of the vascular system
Delivery system (RHCDS) regulated  Cancer
by PD 568 (1976).  Pneumonia
 Accidents
 TB

After pandemic 2021
 Dm
 Hpn ds
 Pneumonia
 Covid
 Heart
JANUARY- SEPTEMBER 2022
1.Ischemic Heart Disease
2.Cerebrovascular Disease
3. Neoplasm
4.Diabetes Mellitus
5.Hypertensive Diseases
6. Pneumonia
7.Other Heart Diseases
8.Chronic Lower respiratory Diseases
9.Remainder of the diseases of the
genitourinary
10. Respiratory Tuberculosis
11. COVID 19
 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.
DOH (DEPARTMENT OF HEALTH)
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(PHILHEALTH).
DOH SECRETARY
 Francisco Duque III — June 20, 2022
 Maria Rosario Vergerie — OIC until
2023
 Current: Health Secretary Teodoro J.
Herbosa
What are the objectives of these national
health goals?
 This ultimately leads to the three
major goals that the Philippine
Health Agenda aspires for:
(1) better health outcomes with no major
disparity among population groups;
(2) financial risk protection for all especially
the poor, marginalized and vulnerable; and
(3) a responsive health system
The Department has adopted the:
 “Sulong Kalusugan” Health Sector
Strategy (HSS) for 2023 to 2028
 which enables us to fast-track
implementation of Primary Health
Care Packages
 Strengthen International Health
Regulations (IHR), and
 Enact the DOH Policy Agenda for
2023 gearing towards a bolstered
health system in support of other
outcomes.
 All these efforts are for the
continued realization of UHC for
every Juan and Juana,”
LOI 949
 PHC to be used as the approach in
the delivery of the essential
services.
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-determination.
1. Health Education
2. Treatment of Locally Endemic
Diseases( Malaria, Filiariasis<
schistosomiasis)
3. Expanded program in Immunization
4. MaternalandChildHealth
5. Provision of Essential Drugs
6. Nutrition
7. Treatment of communicable and non-
communicable diseases. Triple jeopardy:
CD; NCD, emerging diseases
8. 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:
 Health for all in the year 2000 and
Health in the Hands in the year 2020
 Self- Reliance
● 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
1.Improve the level of healthcare
community.
2. Favorable populating growth structure
3. Reduction in the prevalence of
preventable, communicable and other
disease.
4. Reduction in morbidity and mortality
rates especially among infants and children.
Target : Infants= birth to < 12 months
Children = under five ( 12 months to 59
months
5. Extension of essential health services
with priority given to the underserved
sectors.
6. Improvement in basic sanitation.
7. Development of the capability of the
community aimed at self- reliance.
8. Maximizing the contribution of the other
sectors for the social and economic
development of the community.
RA 6675: GENERICS ACT OF 1988:
Implementing
“Oplan Walang Reseta Program” — Solution
to the absence of a medical officer who
prescribed the medicines so PHN are given
the responsibility to prescribe generic
medicines.
“Walong wastong Gamot Program” —
available in generics in “Botika sa baryo” &
Health Center.
 Father of Generics Act: Dr. Alfredo
Bengzon
HERBAL PLANTS
RA 8423: Alternative Traditional Medicine
Law — A program where patient may opt to
use herbal plants especially for drugs that
are not available in dosage form or patients
has no financial means to buy the drug.
Traditional Medicine:
 Use of Herbal Plants
CRITERIA IN THE USE OF APPROPRIATE
TECHNOLOGY
1. Effectiveness and safety
2. Complexity - simple
3. Cost
4. Scope of technology
5. Acceptability
6. feasibility
ELEMENTS
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, 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 articles which are necessary for
and economic factors as its giving care.
determinant. Good Health therefore,
is manifested by the progressive PRINCIPLES
improvements in the living ● Performing the bag technique will
conditions and quality of life enjoyed minimize, if not, prevent the spread of any
by the community residents infection.
 Development is the quest for an ● It saves time and effort in the
improved quality of life for all. performance of nursing procedures.
Development is multidimensional. It ● The bag technique can be performed in a
has political, social, cultural, variety of ways depending
institutional and environmental on the agency’s policy, the home situation,
dimensions (Gonzales 1994). or as long as principles of avoiding transfer
Therefore, it is measured by the of infection are always observed.
ability of people to satisfy their basic
needs. CONTENTS
 Multi sectoral approach The following are the contents of a Public
 Intersectoral — CHED, DEPED, Health Midwife bag:
DSWD, DTI, LGU, DA
 Intrasectoral — within the health ● Paper lining
sector ● Extra paper for making waste bag
● Plastic/linen lining
7. Social Mobilization ● Apron
— It enhances people’s participation or ● Hand towel
governance, support system provided by ● Soap in a soap dish
the government, networking and ● Thermometers (oral and rectal)
developing secondary leaders. ● 2 pairs of scissors (surgical and bandage)
8. Decentralization ● 2 pairs of forceps (curved and straight)
— This ensures empowerment and that ● Disposable syringes with needles (g. 23 &
empowerment can only be 25)
facilitated if the administrative ● Hypodermic needles (g. 19, 22, 23, 25)
structure provides local level ● Sterile dressing
political structures with more ● Cotton balls
substantive responsibilities for ● Cord clamp
development initiators. This also ● Micropore plaster
facilities proper allocation of ● Tape measure
budgetary resources. ● 1 pair of sterile gloves
● Baby’s scale
BAG TECHNIQUE ● Alcohol lamp
— The public health bag is an essential ● 2 test tubes
and indispensable equipment of a ● Test tube holders
public health Midwife which she has ● Solutions of:
to carry along during her home ○ Betadine
visits. It contains basic medication ○ 70% alcohol
○ Zephiran solution of prevention, promotion, cure and
○ Hydrogen peroxide rehabilitation.
○ Spirit of ammnonia
○ Ophthalmic ointment
○ Acetic acid
○ Benedict’s solution
*BP apparatus and stethoscope are carried CLASSIFICATION OF COMMUNITIES:
separately and are never placed in the bag.
Points to consider 1. Urban- high density, a socially
heterogeneous population and a
complex structure, non-agricultural
CHARACTERISTICS OF A occupations; something different
COMMUNITY from an area characterized by
complex interpersonal social
relations.
1. Environment — includes the
physical, biological, socio-cultural,
2. Rural – usually small and the
educational and employment milieu.
occupation is usually farming, fishing
and food gathering. It is peopled by
 The physical environment of the
simple folk characterized by primary
community includes the geography,
group relations, well-knit and having
climate, terrain, natural resources
a high degree of group feeling.
and structural entities (buildings
such as schools, workplaces and
3. Rurban – a combination of the first
homes).
two.
 The biological environment of the
community includes various flora,
fauna, bacteria, viruses, molds,
COMPONENTS OF A COMMUNITY
fungi, toxic substances, and food and
water supplies.
I. THE CORE – represents the
 The sociocultural environment of the
people that make up the
community reflects the culture,
community. Included in the
values, attitudes, and demographic
community CORE are the
characteristics of the people of the
demographics of the population
community.
as well as the values, beliefs and
the history of the people.
2. Population behavior or lifestyle –
II. Nature and Scope of
This describes the self-responsibility,
Demography — The word
the self-care competency of the
demography was derived from
people in the community.
the Greek words: demos,
3. Human biology – describes the
meaning people and graphos,
genetic characteristics of population.
meaning count. Very simply, it is
4. Systems of Health care – Describes
the study by statistical methods
whether available health care is that
of human population.
 III. 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:
IV. 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.
2020 — 109.6 million
October 22, 2022 — 112.934,928 ( UN data)
 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.
c. 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 — more people die of preventaBLE
Median age — 40
= old
= MORE people die of chronic degenerative
diseases
d. 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.
e. 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
% Of the total population 5000 X .03= 150
Infants — measles immunization
Pregnant women — 3.5% of the total
population 5000 X 0.035 = 175 pregnant
women TT immunization 1-4 years====
11.5%== Feeding program
5000 x .115 ====575 young children
 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)
CBR-10; CDR- 5
5==== 5 people added to the population per
1000 population.
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
100/year
Po = population at an earlier date
T = number of years between time 0 and
time t---- 5years
5000
2. Relative increase = is the actual difference
between the two census counts expressed
in percent relative to the population size
made during at an earlier census.
Relative increase = Pt – Pop
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.
RA 3753
— PD 651 birth reporting 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
58 as of day Jan 22, 2023 Birthday ====Feb
1. 2023=== 59
THE EIGHT (8) SUBSYSTEMS OF THE
COMMUNITY
 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?
 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?
 Fire and Safety – Fire protection
facilities and fire prevention
activities, distribution of these.
  Politics and government – Political
structures present in the community,
decision-making process/pattern,
leadership style observed, etc.
 Health – Health facilities and
activities; distribution, utilization,
ratio of providers to clientele served;
priorities in health, programs
developed, etc.
 Communication – Systems, types of
community existing, forms of
communication, be it formal or
informal, vertical or horizontal; etc.
 Economics – Occupation, types of
economic activities, income, etc.
 Recreation–Recreational
activities/facilities: types,
consumers, appropriateness to
consumers, etc.
A HEALTHY COMMUNITY
 Prompts its members to have a high
degree of awareness that “we are
community”
 Uses its natural resources while
taking steps to conserve them for
future generations.
 Openly recognizes the existence of
sub-groups and welcomes their
participation in community affairs
 Is prepared to meet crises
 Is a problem-solving community; it
identifies, analyzes and organizes to
meet its own needs
 Has open channels of
communication that allows
information to flow among all sub-
groups of its citizens in all directions
 Seeks to make each of its system’s
resources available to all members
of the community
 Has legitimate and effective ways to
settle disputes and meet needs that
arise within the community
 Encourages maximum citizen
participation in decision-making
 Promotes a high level wellness
among all its members.
ELEMENTS OF A HEALTHY COMMUNITY
 People are partners in health care
 People work together to attain goals
 Physical environment promotes
health, safety, order and cleanliness
 Safe water and nutritious food
 Families provide members with basic
needs
 Available, affordable health care
 Primary Health Care approach
FACTORS THAT AFFECT COMMUNITY
HEALTH
 Political
 Socio-economic
 Heredity
 Environment
 Behavior
 Health Care Delivery System
Multisectoral approach
EFFECTS OF A HEALTHY COMMUNITY
Development
 Vital statistics – is the application of
statistical methods and techniques
to the study of vital facts, such as
those concerning births, deaths and
illnesses.
 Statistical data, which relate the
total number of various kinds of
biologic or vital events (like births,
marriages, illnesses and deaths) to
the size and characteristics of the
affected population.
Three categories of Vital Statistics:
A. Fertility or Birth rates
1. Crude Birth Rate – The Crude birth and the impact of birth control
rate is only a rough measure of measures on fertility.
fertility in the population since it
makes use of the mid-year
population (which ignores the B. Mortality/Death rates
number of men and women
incapable of child bearing) as its 1. Crude death rate (CDR). The crude death
denominator. However, it has its rate is a measure of the force of mortality or
advantages. For one, the data are the probability of dying in a population.
easy to obtain, making the rate
readily available. Secondly, the rate
can be used in determining
population growth by subtracting
the crude death rate from it. This
rate is obtained using the following 2. Age-Specific Death Rate This rate gives a
formula: 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.
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- 3.Age and Sex-specific death rate. This rate
bearing age are expected to give is similar to the age-specific death rate but
birth for various reasons. This rate is specifies the sex as well.
obtained by the following formula:

3. Age-Specific Fertility Rate – One of 4.Cause-specific death rate. This rate

the most accurate refinements made specifies the cause rather than the age and
in the study of fertility is the age- sex. It is obtained by the following formula:
specific fertility rate. This rate
permits a more in-depth study of the
differences in fertility at specific ages
throughout the reproductive period
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.
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.
7. Infant Mortality Rate (IMR). This rate is
considered one of the most sensitive indices
of the health conditions obtained in a
population.
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.
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.
11. Perinatal Mortality Rate. (PMR). With
the continuing improvement in maternal
care in general and the pre-natal in
particular, the maternal mortality rate has
declined considerably especially in
developed countries.
 C. MORBIDITY/SICKNESSRATES
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.
2. Prevalence Rate. When chronic diseases
constitute the major medical 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:
 The following are factors that should be
taken into consideration in the
interpretation of rates:
1. Definition/Classification of the event
INTERPRETATION OF VITAL in either numerator or Denominator.
This refers to the definition of
STATISTICS certain terms like cause of death or
maternal death and to the accuracy
of diagnosis of certain diseases.
A.) SOURCES OF DATA
2. Accuracy of the Court of event or
population concerned. This refers
1. Vital registration records. The Civil
mainly to the completeness or
Registry Law (Act No. 3753) requires
adequacy of coverage of the count.
the registration of all births and
In the Philippines, although the law
deaths including fetal deaths.
provides for the compulsory
2. Weekly reports from field Health
registration of births and deaths and
Personnel. Data on notifiable
the reporting of notifiable diseases,
diseases are based on information
there are still deficiencies in the
gathered from field health
observance of the law.
personnel. The Law on Reporting
Notifiable Diseases I(Act No. 3573)
Factors that may affect the
provides that any case of notifiable
reporting/registration of vital events:
disease shall be reported weekly
through the nearest provincial and
a. Not all diseases are
city health officer to the Disease
notifiable/reportable in the country,
Intelligence Center (DIC) of the
so that it is very difficult to obtain
Ministry of Health.
data on these diseases, which are
3. Population censuses
not reportable.
B.) CLASSIFICATION OF DATA
Diseases which will be monitored by the
rural health Midwife at least weekly:
Guidelines in the classification of data:
 Measles
1. Classification of Vital Events. All vital
 Acute-poliomyelitis
events are registered and reported
 Severe acute Diarrhea
by place of occurrence, not by place
 Neonatal tetanus
of residence. Classified into regions,
 AIDS
provinces, and cities.
2. Reckoning of age. Age should be
Diseases which should be reported within
recorded as of the last birthday.
24 hours:
3. Classification of disease and causes
of deaths.
 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
Epidemiology
Definition:
 Science concerned with the
circumstances under which diseases
occur, where diseases tend to
flourish and where they do not.
 Study of distribution and
determinants of disease prevalence.
 Is the field of science, which is
concerned with the various factors,
and conditions that determine the
occurrence and distribution of
health, disease, defects, disability
and death among groups of
individuals.
 Is the study of the distribution and
dynamics of disease occurrence in
human populations with the aim in
view of identifying factors of
causation as a basis for determining
preventive and control measures.
Terms used in epidemiology
Endemic – the constant presence of a
disease or infectious agent within a given
geographic area. There is equal number of
susceptible and immunes in the said
population.
Epidemic – the occurrence in a community
or region of cases of a disease condition
clearly in excess of normal expectancy and
derived from a common or propagated
source. There are more susceptible than the
immunes.
Pandemic – denoting a disease affecting or
attacking all or a large portion of the
population; extensively epidemic with wide
geographic distribution.
Sporadic – A term describing the occurrence
of a few cases of a disease every now and
then in a geographic area. There are more
immunes than susceptibles.
Infection – the entry and development of an
infectious agent in the body of man or
animal.
Infectious agent – an organism, chiefly a
microorganism but including helminths that
is capable of producing infection or
infectious disease.
Infectious disease – an apparent or
manifest condition of man or animals
resulting from an infection.
Incubation period – the time interval
between exposure to an infectious agent
and the appearance of the first signs and
symptoms of the disease in question.
Source of infection – the person, animal,
object or substance from which an
infectious agent passes immediately to a
host.
Primary case – the first case that occurs to a
family or community as a unit.
Secondary case – a case resulting from a
primary case.
Reservoir – any human being, animal,
anthropod, plant, soil, or inanimate object
in which and infectious agent normally lives
and multiplies and on which it depends
primarily for survival and reproduces itself
in such a manner that it can be transmitted
to a susceptible host.
Susceptible- a person or animal presumably
not possessing sufficient resistance against
a particular agent to prevent contracting a
disease if or when exposed to the agent.
Carrier – A person (or animal) who harbors
a specific disease causing agent, in the
absence of clinical manifestations and who
served as a source of infection for others.
Contact – A person (or animal) who has
been in association with the infected person
or animal or a contaminated environment.
Incidence – frequency or occurrence of new
cases of a disease in a population over a
stated period of time expressed as a rate.
Isolation – limitation of movement of a
person having a communicable disease or of
a carrier who harbors an infectious agent.
Quarantine – restriction of movement of
those who have been in contact with a
communicable disease for a period of time
during which they maybe potentially
infectious to others.
METHODS OF EPIDEMIOLOGIC STUDY
I. Descriptive method. The
epidemiologist seeks an accurate
description of a specific disease
phenomenon that has already
been occurred. He gathers
pertinent data regarding time
(year, season, day) and the place
of occurrence (geographic,
political, subdivision, rural/urban
areas). He investigates
characteristics of persons
affected ( age, sex, ethnic group,
occupation, family history).
II. Formulation of hypotheses –
acceptable hypotheses must be
 consistent with known facts
regarding disease occurrence.
III. Testing of hypotheses – analytic
studies which maybe either
observational or experiment, are
designed to test the hypotheses.