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COMMUNITY HEALTH DEVELOPMENT
Concept of Health Promotion/Disease Prevention
A. HEALTH PROMOTION/DISEASE PREVENTION
Ottawa Charter for Health Promotion
v created through the organization of International Conference on Health Promotion in 1986 by the World Health Organization (WHO), Health and Welfare Canada, and the Canadian Public Health Association. v adopted by 212 participants from 318 countries v remains to be the guiding principle in health promotion efforts currently despite various charters have been issued on health promotion
v The term was first used in 1945 when Henry E. Sigerist, the great medical historian, defined the four major tasks of medicine [(1.) the promotion of health, (2.) the prevention of illness, (3.) the restoration of the sick and (4) rehabilitation] v “the process of enabling people to increase control over and to improve their health” (Ottawa Charter) v activities that, by accentuating the positive, assist the person to develop those resources that will maintain and enhance well-being and improve the quality of life. v activities that a person does for himself in the absence of symptoms in an attempt to remain healthy v any endeavour directed at enhancing the quality of health and well-being of individuals, families, groups, communities and nations through strategies involving supportive environments, coordination of resources, and respect for personal choice and values
v activities designed to protect patients or other members of the public from actual or potential health threats and their harmful consequences.
Action Areas recommended by the Charter to
operationalize the concept of health promotion: 1. Reorient Health Services 2. Develop Personal Skills 3. Build Healthy Public Policy 4. Create Supportive Environments 5. Strengthen Community Action
Principles of Health Promotion cited by WHO:
1. Health promotion everyday life. 2. Health promotion 3. Health promotion 4. Health promotion participation. 5. Health promotion service. involves the population as a whole in the context of their is directed towards action on the determinants of health. combines diverse but complementary methods or approaches. aims particularly at effective and concrete public is primarily a societal and political venture and not a medical Community Health Nursing by Caesar G. Balatero, RN | 1
Culture 10. 4. Health services Figure 1. 3. Physical environment Income and social status Genetics Gender 5.” (WHO.SSSSS -----------------B.Central Luzon College of Science & Technology (CELTECH College). ECOSYSTEM INFLUENCES ON OPTIMUM LEVEL OF FUNCTIONING (OLOF) OLOF – a level at which one can do or function at his best out of a number of possible options and outcomes -----------------. Education 9. Personal behaviour and coping skills 7. and not merely the absence of disease or infirmity. HEALTH AS A MULTIFACTORIAL PHENOMENON Health v “a state of complete physical. mental and social well-being. Employment and working environment 8. Social support networks 6. LEVELS OF PREVENTION LEVEL DEFINITION EXAMPLES | 2 Community Health Nursing by Caesar G. Olongapo City | College of Nursing -----------------.SSSSS -----------------C. 2. 1947) Determinants of Health: 1. Balatero. RN .
v notes that each person has unique personal characteristics and experiences that affect subsequent actions v Health-promoting behavior is the desired behavioral outcome and is the end point in the HPM. revised. Secondary screening. disease chronic pain clinics. and Behavioral outcomes. Behavior-specific cognitions and affect. Community Health Nursing by Caesar G.SSSSS -----------------D. cancer screening. immunization. occupational • rehabilitation after the Prevention therapy. enhanced functional ability and better quality of life at all stages of development. (case finding and screening) Prevention genetic counselling • use of referral services • early treatment of disease • prevention of complications vocational training. speech therapy. RN | 3 . Tertiary therapy. Pender (1982. limiting alcohol being intake. v describes the multi-dimensional nature of persons as they interact within their environment to pursue health. v Health-promoting behaviors should result in improved health. Olongapo City | College of Nursing maintenance of diet & body • specific protection for diseases 1. TB screening. remedial reading -----------------. cessation of • improving general wellPrevention smoking. Pender’s Health Promotion Theory (HPM) v proposed by Nola J. newborn • early detection/diagnosis 2.” v defines health as a positive dynamic state not merely the absence of disease v Health promotion is directed at increasing a client’s level of wellbeing. physical 3. fluoride actual occurrence of a specific application illness or disease BSE. THEORIES/MODEL OF HEALTH PROMOTION 1.Central Luzon College of Science & Technology (CELTECH College). 1996) v designed to be a “complementary counterpart to models of health protection. v focuses on following three areas: Individual characteristics and experiences. • prevention or delay of the handwashing. safe sex. Balatero. Primary weight.
or balance. RN | 4 . Personal socio-cultural factors . self-motivation personal competence. perceived health status and definition of health. body mass index. Personal biological factors – Include variable such as age. Personal psychological factors – Include variables such as self-esteem. agility. Olongapo City | College of Nursing v The final behavioral demand is also influenced by the immediate competing demand and preferences. aerobic capacity. Community Health Nursing by Caesar G. THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL Individual Characteristics and Experiences PRIOR RELATED BEHAVIOR – Frequency of the similar behavior in the past.Central Luzon College of Science & Technology (CELTECH College). acculturation. strength. These factors are predictive of a given behavior and shaped by the nature of the target behavior being considered.Include variables such as race ethnicity. education and socioeconomic status. which can derail an intended health promoting actions. pubertal status. PERSONAL FACTORS – Personal factors categorized as biological. psychological and socio-cultural. Direct and indirect effects on the likelihood of engaging in health-promoting behaviors. gender. Balatero.
increased feelings of efficacy can generate further positive affect. v According to the theory. Balatero. vicarious experiences. Interpersonal influences include: norms (expectations of significant others). In turn. PERCEIVED BARRIERS TO ACTION – Anticipated. is regarded as the most important factor. the greater the feeling of efficacy. Competing preferences are alternative behavior over which individuals exert relatively high control. or attitudes of the others. Situational influences may have direct or indirect influences on health behavior. such as choice of ice cream or apple for a snack HEALTH-PROMOTING BEHAVIOR – Endpoint or action outcome directed toward attaining positive health outcome such as optimal well-being. which can be achieved by participatory modeling. IMMEDIATE COMPETING DEMANDS AND PREFERENCES – Competing demands are those alternative behavior over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. social support (instrumental and emotional encouragement) and modeling (vicarious learning through observing others engaged in a particular behavior). and productive living. Olongapo City | College of Nursing Behavior-Specific Cognition and Affect PERCEIVED BENEFITS OF ACTION – Anticipated positive outcomes that will occur from health behavior. Behavioral Outcome COMMITMENT TO PLAN OF ACTION – The concept of intention and identification of a planned strategy leads to implementation of health behavior. 2. ACTIVITY-RELATED AFFECT– Subjective positive or negative feeling that occur before. PERCEIVED SELF-EFFICACY – Judgment of personal capability to organize and execute a health-promoting behavior. RN | 5 . Perceived self-efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior. personal fulfillment. imagined or real blocks and personal costs of understanding a given behavior. Primary sources of interpersonal influences are families. during and following behavior based on the stimulus properties of the behavior itself. beliefs. Include perceptions of options available.Central Luzon College of Science & Technology (CELTECH College). peers. v Successful performance. Activity-related affect influences perceived self-efficacy. People with weak belief in their self efficacy • • • shy away from difficult tasks (personal threats) have low aspirations and weak commitment to the goals they choose maintain a self diagnostic focus (rather than how to perform) Community Health Nursing by Caesar G. demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. SITUATIONAL INFLUENCES – Personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior. INTERPERSONAL INFLUENCES – Cognition concerning behaviors. and emotional arousal. verbal persuasion. self-efficacy is enhanced by four factors: successful performances. and healthcare providers. Bandura’s Self-Efficacy Theory v A theory of situation-specific self-confidence that proposes that self-efficacy is fundamental to initiating certain behavior necessary for competent performance. which means the more positive the subjective feeling.
. or one's confidence in the ability to successfully perform an action. These concepts were proposed as accounting for people's "readiness to act.Central Luzon College of Science & Technology (CELTECH College). such as being sedentary. Health Belief Model (HBM) developed by Hochbaum. RN | 6 . The HBM was spelled out in terms of four constructs representing the perceived threat and net benefits: perceived susceptibility. or overeating. feels that a negative health condition (e. using condoms will be effective at preventing HIV). This concept was added by Rosenstock and others in 1988 to help the HBM better fit the challenges of changing habitual unhealthy behaviors. Rosenstock and Kegels Core Assumptions and Statements The HBM is based on the understanding that a person will take a health-related action (e. and perceived barriers. perceived severity..g. believes that he/she can successfully take a recommended health action (e.. has a positive expectation that by taking a recommended action. he/she can use condoms comfortably and with confidence). Balatero. and 3. smoking... obstacles & adverse outcomes • attribute failures to deficient capabilities • slacken their efforts or give up quickly in face of difficulty • slow to recover their sense of efficacy after failures or setbacks • prone to stress & depression People with strong belief in their efficacy • • • • • • • set challenging goals & sustain strong commitments to their goals approach difficult tasks as challenges rather than as threats maintain a task diagnostic focus attribute failures to insufficient effort heighten effort in face of difficulties quickly recover their sense of efficacy after failure or setback display low vulnerability to stress & depression 3. Olongapo City | College of Nursing • dwell on personal deficiencies.g.g. use condoms) if that person: 1." An added concept. would activate that readiness and stimulate overt behavior. Community Health Nursing by Caesar G. perceived benefits. 2. A recent addition to the HBM is the concept of self-efficacy. he/she will avoid a negative health condition (e. cues to action. HIV) can be avoided.g.
reminders. heighten perceived susceptibility if too low. so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.Central Luzon College of Science & Technology (CELTECH College). CONCEPT OF PUBLIC HEALTH Public Health v Dr. control of communicable diseases. One's opinion of the tangible Identify and reduce barriers and psychological costs of the through reassurance. prolonging life 3. promote awareness. Balatero. guidance in take action performing action. and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health. control of 1. promoting health and efficiency through organized community effort for the sanitation of the environment. the education of individuals in personal hygiene.SSSSS ------------------ Concept of Public Health and Community Health Nursing A.E. Perceived Severity One's opinion of how serious a Specify consequences of the risk condition and its and the condition consequences are One's belief in the efficacy of Define action to take.” In diagram: science and art of → 1. sanitation of the → through . advised action assistance. C. risk levels. personalize risk based on a person's features or behavior. how. preventing disease organized community effort 2. the organization of medical and nursing services for the early diagnosis and preventive treatment of disease. promoting health and efficiency ↓ for the: to ensure everyone environment a standard of living communicable diseases Community Health Nursing by Caesar G. where. Perceived Benefits Perceived Barriers Cues to Action Self-Efficacy Confidence in one's ability to Provide training. the advised action to reduce when. prolonging life. RN | 7 ← 2. clarify the positive effects to risk or seriousness of impact be expected. Olongapo City | College of Nursing Concept Perceived Susceptibility Definition One's opinion of chances of getting a condition Application Define population(s) at risk. incentives. Winslow: “science and art of preventing disease. -----------------. Strategies to activate "readiness" Provide how-to information.
RN | 8 . 9. Balatero. development and implementation of innovative solutions Community Health Nursing by Caesar G. mental. and empowerment ensuring quality or health services research.Central Luzon College of Science & Technology (CELTECH College). promotion of health and equitable health gain Essential public health functions 1. prolonging life and efficiency to enable every citizen to realize his birthright of health and longevity.” 4 further presented the core business of public health as: 1. 7. social participation. education of individuals in personal hygiene ↓ 4. and social well-being and longevity. 3. healthy public policy 5. 6. organization of medical and nursing services adequate for the maintenance of health for the early dx and preventive tx of disease 5. 8. Olongapo City | College of Nursing 3.” 4 GOAL: contribute to the most effective total development and life of the individual and his society v WHO: “art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number. disease control 2. health protection 4. v Hanlon: “Public health is dedicated to the common attainment of the highest level of physical. 5. development of social machinery ↓ so organizing these benefits as to ↓ Enable every citizen to realize his birthright of health and longevity In short: Public health is a science and art of preventing disease. 4. health situation monitoring and analysis epidemiological surveillance development of policies and planning strategic management of health systems and services regulation and enforcement to protect public health HR dev’t and planning health promotion. 2. injury prevention 3.
3. 5. was appointed. HISTORICAL BACKGROUND OF PUBLIC HEALTH NURSING IN THE PHILIPPINES 1898 – start of PHN as embedded in history of the DOH which was first established as the Department of Public Works. public health and some phases of social assistance and functions as part of the total public health program for the promotion of health. created several offices and services 2005-2006 – development of the Rationalization Plan Functions of Public Health Nurse 1. 7. RN | 9 . Education and Hygiene 1912 – the Fajardo Act created Sanitary Divisions 1914 – school nursing was rendered by a nurse employed by the Bureau of Health in Leyte 1916-1918 – Miss Perlita Clark took charge of the PHN work 1919 – the first Filipino nurse supervisor under Bureau of Health. 1928 – first convention of nurse was held 1986 – reorganization of Department of Health 1987-1989 – E. Balatero. rehab of illness and disability. No. 6.” National League of Philippine Government Nurses • came up with the Standards of Public Health Nursing in the Philippines 2005 ↓ Differentiated PHN and CHN only in one area: setting of work as dictated by funding. Management function Supervisory function Nursing care function Collaborating and coordinating function Health promotion and education function Training function Research function -----------------. v refers to the practice of nursing in the national and local government health departments. It is community health nursing practiced in the public sector.SSSSS -----------------B.Central Luzon College of Science & Technology (CELTECH College). Miss Carmen del Rosario. 4. CONCEPT OF COMMUNITY HEALTH NURSING Community Health Nursing Community Health Nursing by Caesar G. improvement of the conditions in the social and physical environment. Olongapo City | College of Nursing Public Health Nursing v a term coined by Lillian Wald to denote a service available to all people.O. v WHO Expert Committee on Nursing: “a special field of nursing that combines the skills of nursing. 119 reorganization of Department of Health. 2.
Health Monitor 8. Health teaching is a primary responsibility 6. resourcefulness 10. prevention. Cobb and Jones) 1. and individuals at home. 3. utilize existing active organized groups in the community 11. 2. Planner/Programmer Counsellor 2. in school. CH nurse must understand objectives and policies of his agency 3. RN . 4. participate in the development of over-all health plan provide quality nursing services coordinate nursing services participate/conduct researches provide staff development Principles (adapted from those of Mary S. educative supervision 12. Leahy.Using the nursing process for periodic measurements of progress Goal • help communities and families to cope with the discontinuities in health and threats Ultimate Goal • raise the level of health of the citizenry Objectives 1. Olongapo City | College of Nursing v Jacobson: CHN is a learned practice discipline 4 Ultimate goal: contribute to the promotion of client’s OLOF v Ruth B. Manager/Supervisor 6.Utilizes current knowledge 6.Health promotion – primary focus 2. 5. Provider of Nursing Care 3. periodic evaluation of CHN services 8. groups. Trainer/Health Educator/ 7. care of the sick at home and rehabilitation. of illness. Freeman: CHN is a service rendered by a professional nurse with the community.Practice is extended to benefit not only the individual but the whole family and community 3.Community health nurses are generalists 4.Contact with client/s may be over a long period of time and include all ages and all types of health care 5.Central Luzon College of Science & Technology (CELTECH College). Philosophy • CHN is based on the worth and dignity of man (Dr. Role Model | 10 Community Health Nursing by Caesar G. in health centers. accurate recording and reporting Roles of a CH (even PH) Nurse 1. in places of work for the promotion of health. CHN must be equitable 5. family is the unit of service 4. families. is based on recognized needs of clients 2. in clinics. continuing staff education programs be provided 9. CH nurse works as a member of the health team 7. Gardner. Margaret Shetland) Concepts 1. Balatero.
Nightingale’s theory of environment 2. v She challenged the common notion that a main determinant for unhealthful behavioral choice is lack of knowledge. enforcement directed at mandatory regulation to achieve better health. Human/Biological • 2. For these 3 general categories of nursing intervention have also been put forward. Change agent 5. They have given 3 essential elements of population-focused nursing that stem from these 2 fields: Community Health Nursing by Caesar G. v Intervention target is in 4 categories • 1. Community Organizer 9. population-focused care v The basic treatise is that behavioral patterns of populations and individuals who make up populations are a result of habitual selection from limited choices. Coordinator of Services 10. Medical/technological/organizational • 4. education directed toward voluntary change in the attitude and behaviour of the subjects 2. Block and Josten’s Ethical Theory of population focused nursing 10. Salmon White’s Construct for Public health nursing 9. Canadian Model Milio’s Framework of Prevention Nancy Milio v a nurse and leader in public health policy and public health education v developed a framework for prevention that includes concepts of community-oriented. Neuman’s health care system model 4. engineering directed at managing risk-related variables 3.e. White’s Construct for Public Health Nursing Mark Salmon White v describes a public health as an organized societal effort to protect. they are: 1. v gave 3 practice priorities i. promote and restore the health of people and public health nursing as focused on achieving and maintaining public health. RN | 11 . Roger’s model of the science and unitary man 5. Pender’s health promotion model 6. Environmental • 3. (2) protection against disease and external agents and (3) promotion of health. Balatero.. Roy’s adaptation model 7.Central Luzon College of Science & Technology (CELTECH College). Social Block and Josten’s Ethical Theory of Population-Focused Nursing Derryl Block and Lavohn Josten (public health educators) v proposed this theory based on intersecting fields of public health and nursing. Milio’s Framework of prevention 8. Olongapo City | College of Nursing 4. Recorder/Reporter/Statistician/Researcher Theories and Models related to CHN The commonly used theories are: 1. (1) prevention of disease and poor health. Orem’s Self care model 3.
Nutrition Objectives of School Nursing General: To promote and maintain the health of the school populace by providing comprehensive and quality nursing care. ian Model for Community The community health nurse works with individuals. 5.b. HEALTH and NUTRITION CENTER (HNC) of the Department of Education (DepEd) v is mandated to safeguard the health and nutritional well-being of the total school population v has two divisions: 1. Dental 1. Health advocacy Community Health Nursing by Caesar G. 3. teaching and non-teaching personnel of the schools. Health Education 2. Create awareness among school children. families. personnel and administrators on the importance of the promotive and preventive aspects of health through health education.Central Luzon College of Science & Technology (CELTECH College).d. an obligation to population 3. Provide quality nursing service to the school population. 4. groups. Hence it implies to nursing that relation-based care is very important in population focused care. populations. centrality of relationship-based care the first two are from public health and the third element from nursing. Specific: 1. Medical 1.a.SSSSS -----------------C. 2. systems and/or society. Health 1. Establish/strengthen linkages with government and non-government organizations/agencies for school community health work. -----------------. Conduct and participate in researches related to nursing care. Duties and Responsibilities of School Nurses 1.c. and 6. RN | 12 . Encourage the provision of standard functional facilities. Provide nursing personnel with opportunities for continuing education and training. but at all times the health of the person or community is the focus and motivation from which nursing actions flow. Olongapo City | College of Nursing 1. Balatero. v the primary role of the school nurse is to support student learning and ensure that educational potential is not hampered by unmet health needs. SPECIALIZED FIELDS IN COMMUNITY & PUBLIC HEALTH NURSING School Nursing v a type of public health nursing that focuses on the promotion of health and wellness of the pupils/students. the primacy of prevention 2. communities. Nursing 1.
Basic management skills 6. Standard vision testing for children 5. Health assessment 4. Social mobilization skills 4. Height and weight measurement and nutritional status determination S children 10 yrs.) 3. Health counselling skills 3.Central Luzon College of Science & Technology (CELTECH College). old – weight-for-age and height-for-age indicators are used S children 10 yrs. Olongapo City | College of Nursing 2. Balatero. Health and nutrition assessment (including other screening procedures such as vision and hearing. Health and nutrition education activities 11. Attendance to emergency cases 9. Communicable disease control 13. Medical referrals 8. 3. Monitoring and evaluation of programs and projects Skills Needed by a School Nurse 1. old – body mass index (BMI) is used S deworming – 120 days. Rapid classroom inspection 16. Good oral and written communication skills 5. School plant inspection for healthy environment 15. Home visitation Occupational Health Nursing v an autonomous practice requiring independent decisions and creative solutions to complex occupational and environmental health and safety problems v focus: preservation and restoration of the health of workers and working populations v mission: to assure so far as possible every working man and woman in the country is safe and in healthful working conditions. Community outreach like attending community assemblies and organizing school community health councils 8. Life skills Functions of the School Nurse 1. Organization of school-community health and nutrition councils 12. 124 – mandates that all schools are to provide school clinics for the treatment of minor ailments and attendance to emergency cases. School health and nutrition survey 2. RN | 13 . Home visits 7. Recording and reporting of accomplishments 9. Student health counselling 10. Treatment of common ailments and attending to emergency cases 5. Supervision of the health and safety of the school plant 4. Referrals and follow-up of pupils and personnel 6. Ear examination 6.A. Establishment of data bank on school health and nutrition activities 14. Assessment and screening skills 2. Community Health Nursing by Caesar G. parental consent is a must 7. Putting up a functional school clinic S R.
local vibrations E. electric and magnetic fields. medications. parasites D. shift work. repeated awkward movements with handheld tools. Chemical hazards – solution. synthetic textiles. frequent repetition of a limited movement. 626 – promotes and develops a tax exempt employees’ compensation whereby employees and their dependents.SSSSS ------------------ The Philippine Health Care Delivery System A. Mechanical hazards – inadequate work-station and tool design. overtime. and pharmaceuticals C. explosives.Central Luzon College of Science & Technology (CELTECH College). poorly defined expectations and work instructions. Physical hazards – radiation. RESTRUCTURED HEALTH CARE DELIVERY SYSTEM Philippine Health Care Delivery System composed of two sectors: 1. aerosols. unsafe working conditions. RN | 14 . oils. bacteria. Biological hazards – viruses. may promptly secure adequate income benefit. other than one resulting from an occupational injury. private sector – largely market-oriented and where health care is paid through user fees at the point of service PUBLIC SECTOR (at the national level) Department of Health (DOH) (at the local level) Local Government Units (LGUs) v runs the local health system with the devolution of health services Community Health Nursing by Caesar G. racial inequality. noise. vibration B. solvents. fungi. public sector – largely financed through a tax-based budgeting system at both national and local levels and where health care is generally given free at the point of service (although socialized user fees have been introduced in recent years for certain types of services) 2.D. mold. sexual harassment. microwaves. mists. particulate matter (fumes and dust). sprain. metals. pesticides. vapors. caused by exposure to environmental factors associated with employment. fracture. or amputation that results from a single incident in the work environment : Occupational illness – any abnormal condition or disorder. Psychosocial hazards – interpersonal conflict. role conflict. and medical or related benefits. temperature extremes. absent or limited hob reward Work-Related Injury and Illness : Occupational injury – any injury such as a cut. in the event of workconnected disability or death. -----------------. limited autonomy. Balatero. gases. The Worker’s Compensation S P. lasers. Olongapo City | College of Nursing Issues in Occupational Health Nursing A.
307. 308 Act No.Central Luzon College of Science & Technology (CELTECH College). 157 Act Nos. 1407 Act No. 4007 Act No.SSSSS -----------------B.D. THE DEPARTMENT OF HEALTH Department of Health (DOH) v mandated as the lead agency in health v has a regional field office in every region v maintains specialty hospitals. Corazon Aquino) Roles and Functions 1. Education and Hygiene (July) Board of Health 1901 (Dec. etc. 2468 Act No. human resource development and other health-related services. 1397 E. manufacture of medicines. regional hospitals and medical centers v also maintains provincial health teams made up of DOH representatives to the local health boards and personnel involved in communicable disease control HISTORICAL BACKGROUND YEAR NAME 1888 Superior Board of Health and Charity 1898 Department of Public Works. research and development.O. and other health and nutrition products.) Insular Board of Health 1901 1905 Bureau of Health 1915 Philippine Health Service 1932 Bureau of Health 1939 Department of Health and Public Welfare 1947 Department of Health and Public Welfare (reorg) 1978 Ministry of Health 1987 Department of Health (through Pres. medical supplies. equipment. Balatero. No. ADMINistrator of Specific Services v Manage selected national health facilities and hospitals with modern and advanced facilities that shall serve as national referral centers and selected health facilities at sub-national levels that are referral centers for local health systems v Administer direct services for emergent health concerns that require new complicated technologies.) Community Health Nursing by Caesar G. 119 . Olongapo City | College of Nursing v provincial government manages: • provincial hospitals • district hospitals v city/municipal government manages: • health centers • rural health units (RHUs) • barangay health stations (BHSs) PRIVATE SECTOR v includes for-profit and non-profit health providers v includes providing health services in clinics and hospitals. vaccines. -----------------. HIV-AIDS. RN | 15 LAW ------------Act No. 94 P. No. schistosomiasis. administer special components of specific programs (TB.O. health insurance. 430 E.
sustainable and quality health for all Filipinos. Balatero. especially the poor and shall lead the quest for excellence in health. Vision: The DOH is the leader. CAPAcity Builder and Enabler v Innovate new strategies in health to improve the effectiveness of health programs. health products and health services that will produce the best health systems for the country. in cases of epidemic and other widespread public danger 2. plans. v Provide leadership in the formulation. Goal: Health Sector Reform Agenda (HSRA) v the overriding goal of the DOH v support mechanisms will be through sound organizational development. injuries and catastrophic events. strong policies. LEADership in Health v Serve as the national policy and regulatory institution. monitoring and evaluation of national health policies. Rationale for Health Sector Reform Although there has been a significant improvement in the health status of Filipinos for the last 50 years. and programs. 3. The DOH shall do this by seeking all ways to establish performance standards for health human resources. poor health care financing and inefficient sourcing or generation of funds FRAMEWORK FOR IMPLEMENTATION OF HSRA: FOURmula ONE for Health Community Health Nursing by Caesar G.Central Luzon College of Science & Technology (CELTECH College). programs and policies v Ensure the highest achievable standards of quality health care. systems and procedures. health promotion and health protection. Olongapo City | College of Nursing v Administer health emergency response services. Mission: Guarantee. and adequate financial resources. inadequate regulatory mechanisms for health services 3. inappropriate health delivery system 2. health facilities and institutions. and disseminate policy research outputs to ensure informed public participation in policy decision-making. v Exercise oversight functions. staunch advocate and model in promoting Health for All in the Philippines. and monitoring and evaluation of national health plans. capable human resources. the following conditions are still seen among the population: slowing down in the reduction in the Infant Mortality Rate (IMR) and the Maternal Mortality Rate (MMR) persistence of large variations in health status across population groups and geographic areas high burden from infectious diseases rising burden from chronic and degenerative diseases unattended emerging health risks from environmental and workrelated factors burden of disease is heaviest on the poor The reasons why the above conditions are still seen among the population can be explained by the following factors: 1. v Serve as advocate in the adoption of health policies. plans and programs to address national and sectoral concerns. equitable. including referral and networking system for trauma. initiate public discussion on health issues and undertaking. RN | 16 .
Health financing v The goal of this heath reform area is to foster greater. Health regulation v the goal is to ensure the quality and affordability of health goods and services Health service delivery v the goal is to improve and ensure the accessibility and availability of basic and essential health care in both public and private facilities and services Good governance v the goal is to enhance health system performance at the national and local levels 2. 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 Community Health Nursing by Caesar G. v The Philippine Health Insurance Corporation (PHIC) through the National Health Insurance Program and the Department of Health through sector-wide policy support will lead this component jointly. Olongapo City | College of Nursing v intends to implement critical interventions as a single package backed by effective management infrastructure and financing arrangements following a sector-wide approach Goals of FOURmula ONE for Health 1. 4. Equitable health care financing Four Elements of the Strategy 1. c. Balatero.Central Luzon College of Science & Technology (CELTECH College). governance – as it is a prudent purchaser of health care thereby influencing the health care market and related institutions Objectives of the Health Sector Reform Agenda a. 3. d. b. More responsive health systems 3. National Health Insurance Program (NHIP) v a key feature of the FOURmula ONE for Health v supports each of the elements in terms of: financing – as it reduces the financial burden placed on Filipinos by health care costs regulation – as the NHIP’s role in accreditation and payments based on quality acts as driver for improved performance in the health care service delivery – as the NHIP demands fair compensation for the costs of care directed at providing essential goods and services in health. better and sustained investments in health. Better health outcomes 2. f. e. RN | 17 .
shared responsibility. Improve efficiency in the allocation. civil society and the communities in making crucial decisions for health Global and National Health Imperatives Public health systems are operating within a context of ongoing changes. Olongapo City | College of Nursing g. 4. including the emergence and re-emergence of new diseases and in the prevalence of risk and protective factors. Reduce the cost and ensure the quality of essential drugs i. v sets the targets and the critical indicators. Program managers. the global community. Institute health regulatory reforms to ensure quality and safety of health goods and services j. freedom. MILLENNIUM DEVELOPMENT GOALS (MDGs) v exemplifies the vision of poverty reduction and sustainable development v are based on the fundamental values of solidarity. The 8 Millennium Development Goals (MDGs) Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve mental health Community Health Nursing by Caesar G. 2. and laying down new avenues for improved interventions. production and utilization or resources for health Roadmap for All Stakeholders in Health: National Objectives for Health 2005 to 2010 v provides the road map for stakeholders in health and health-related sectors to intensify and harmonize their efforts to attain its time-honored vision of health for all Filipinos and continue its avowed mission to ensure accessibility and quality of health care to improve the quality of life of all Filipinos. current strategies based on field experiences. Pursue public health and hospital reforms h. development partners. Expand the coverage of social health insurance m. 2. especially the poor. local government executives. RN 1. represented by the United Nations General Assembly. tolerance. 3. Balatero. Strengthen health governance and management support systems k. 5.Central Luzon College of Science & Technology (CELTECH College). Shifts in demographic and epidemiological trends in diseases. health. 4. These changes include: 1. and equality. In response to above trends. Mobilize more resources for health n. New technologies for health care. Health reforms. decided to adopt a common vision of poverty reduction and sustainable development in September 2000. Existing and emerging environmental hazards some associated with globalization. 3. v provides concrete handle that would guide policy makers. communication and information. respect for nature. | 18 . which exert a number of pressures on the public health system. Institute safety nets for the vulnerable and marginalized groups l.
DEVOLUTION OF HEALTH SERVICES (RA 7160) Republic Act 7160 v took place in 1991 v all structures. and others at the barangay health stations and rural health units.Central Luzon College of Science & Technology (CELTECH College). Levels of Health Care and Referral System 1. Olongapo City | College of Nursing 6. In order to achieve these goals. Balatero. TERTIARY LEVEL OF CARE v rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals. PRIMARY LEVEL OF CARE v devolved to the cities and the municipalities v health care provided by center physicians. rural health midwives. RN | 19 . Combat HIV/AIDS. traditional healers. and barangay health stations (BHS) Community Health Nursing by Caesar G. 3. v referral center for the secondary care facilities -----------------. all the MDGs are health or health-related. and specialized hospitals such as the Philippine Heart Center. the participation of all members of the society from both developing and developed countries is required. Ensure environmental sustainability 8. Provincial governments v operate the hospital system. and out-patient departments of provincial hospitals. SECONDARY LEVEL OF CARE v given by physicians with basic health training v usually given in health facilities either privately owned or government-operated such as infirmaries. 2. municipal and district hospitals. rural health units (RHU). Devolution v made local government executives responsible to operate local health care services. malaria and other diseases 7. barangay health workers. Develop a global partnership for development Except for goals 2 and 3. personnel and budgetary allocations from the provincial health level down to the barangays were devolved to the local government units to facilitate health service delivery. provincial and district hospitals City/municipal governments v operate the health centers (HC). public health nurses.SSSSS -----------------C.
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