Community Health Nursing

Joy Colindres,RN,MAN

Overview of Community Health Nursing
Community Health Nursing as a Field of Nursing Practice

Historical Perspective 

has been directed for a need to reduce pain with comfort measures

Influence of Ancient Cultures on Public Health
Egyptians, Hebrew, Greeks, Roman

Egyptians Civilizations
Built irrigations and granaries for proper storage of foods  Practice of prophylaxis by the medicine man and high priest  Emphasize on personal hygiene  Sanitation measures (removal of refuse and fumigation esp. during epidemic) 

Founders of public hygiene  Moses ± Father of Sanitation  Mosaic Health Code ± focus on individual, family and community hygiene  


of personal hygiene  Environmental sanitation

quarantine. cleanliness) Environmental Hygiene of food  Methods of disposal of excreta  Detecting and reporting of disease  Practice of isolation. hours of work. fumigations and disinfections  Handwashing  Inspection .Personal Hygiene (rest.


± Father of Medicine

of preventive medicines  Introduce principles of interrelationship physicians and mental health

´ A healthy mind dwells in a healthy body.µ


to the field of sanitations  Appointing public health medicine officer  Establish hospitals which emphasize on preventive and curative aspects of care

Development of Public Health Nursing as a World Movement
Early Christian Period (1st Century) Middle Ages Renaissance Early 19th Century

Early Christian Period st Century) (1 

of Deaconesses 


nurse Forerunners of community health nurses Endeavored to practice the corporal works of Mercy (feeding the hungry, caring for the sick, burying the dead)

Middle Ages 

of Flanders

as nursing sister in the

hospital  gives care to the sick in their homes  staying with the dying and consoles the family


St. Vincent the Paul ± introduce modern principles of visiting nursing and social services
Taught that discrimination is harmful  Emphasized the concept of helping people help themselves  Organized Daughters of Charity  Family is the basic unit of service  Recognized the importance of supervision of those who render services of the sick 

 Frederika Munster Fliedner ± organized Women¶s Society for visiting and nursing the sick poor in their homes  . went on tour to raise fund for a program on social work.Early 19th Century Pastor Theodor Fliedner ± a German pastor.

Development of Modern Public Health Nursing .

Period of Empirical Environmental Sanitation (1840-1890) (1840 Emphasized Removal measures to control communicable diseases: of refuse waste Clean-up campaigns of prisons and Cleanasylum Improvement of working conditions of women and children .

 Florence Nightingale ± ³Mother of Nursing´ . attention to patients individual needs and respect for patient¶s rights. .(1873) developed a model for independent nursing schools to teach critical thinking.

hospital. and district nurse .William Rathborne ± Father of modern district nursing ± organized training school for nurses. private duty.

Period of Scientific control of communicable diseases (1890-1910) (1890- Application of bacteriology and immunology .

Period of Health Education (1910 to present) Emphasized on education for prevention of diseases with active cooperation of individual in health action .

Public Health Nursing in the Philippines PrePre-Spanish Era ± no records  Spanish Regime (1591-1898) (1591 Bro. provincial and national health officers  . Juan Clemente (1577) ± started public health services  Introduction of water sanitation  Introduction of small pox vaccine  Creation of position of district.

American Regime (1898-1946) (1898 1898 ± creation of Board of Health for physicians  1899 ± appointment of the 1st commissioner of health  1901 ± Act No. 309 created Provincial and Municipal Boards of Health  . 157 created Board of Health for the City of Manila. Act No.

1905 ± Act No. 2156) created Sanitary Division. In the same year public health nursing in the Philippines started.  . 1407 (reorganization act) abolish Board of Health and was taken over by the Bureau of Health under the Department of Interior  1906 ± creation of Bureau of Health  1912 ± Fajardo Act (Act No.

Reorganization Act No. Perlita Clark took charge of the public health nursing 1917 ± 4 nursing graduates from Manila were employed to worked in the city school . nurseRosario Pastor. 1916 to 1918 ± Ms. 2462 ± created the office of General Inspection.   1915 ± Bureau of Health was renamed Philippine Health Service. headed by nurse-physician Dr.

The program was later extended to the province incorporation with Bureau of Public Welfare . hold clinic and dispensary work with special emphasis on maternal and child care. Balbina Basa was assigned to make a house to house visit. Philippine National Red Cross introduced the operation of puericulture. Manila when visiting nurse Ms. 1919    Public health nursing was inaugurated in Tondo.

In later year 4 more school were establish  .Ms. Carmen del Rosario was appointed as the first Filipino nurse under the Bureau of Health  1923 ± established 2 government schools of nursing: Zamboanga General Hospital School of Nursing and Baguio General Hospital in Northern Luzon.

1928 ± Fist convention of nurses were held  1933 ± Reorganization Act No. 4007. the Division of Maternal and Child Health of the Public Welfare Commission was transferred to the Bureau of Health  1940 ± The Department of Health and Welfare was created  .

technical assistant in nursing of the Ministry of Health and concurrent president of Filipino Nurses Association recommended the creation of a nursing office in the Ministry of Health. the Bureau of Health increased the number of public health nurse. Mrs. . Genara de Guzman.  Japanese Regime (1942-1945) ± Public health (1942nursing were interrupted 1946 ± after world war.

Era of Republic of the Philippines (1949 to present)  1947 ± Reorganization of government offices under EO No. 94: Bureau of Public Welfare to the office of the president and renamed as Department of Health  1953 ± the office of Health Education and Personnel Training was created  .

1954 ± Republic Act 1082 was passed creating Rural Health Units  June 1957 ± Republic Act 1891 ± an act that strengthen health and dental services in the rural health area  1975 ± Formulation of National Health Plan and the restructured Health Care Delivery System  .May 18.

851. . and Bureau of Food and Drug 1986 ± The Ministry of Health became Department of Health again 1991 ± RA 7160 (Local Government Code). Devolution ± transfer of power from the national to local government which aimed to built their capabilities for self-government and developed a selfselfself-reliant communities.   1982 ± Executive Order No. the health education and manpower development service was created.

1993 to 1998 ± National League of Philippine Government Nurses was organized  1996 ± Primary Health Care as a strategies to attain Health for all by the year 2000  1999 ± Creation of National Health Planning Committee and Inter-Local InterHealth Zones through EO 205  .

Estrada.1994 ± EO 102 signed by Pres. effectiveness and equity of health care delivery . precision and effective coordination towards improving the efficiency. nursing positions were devolved 1999 to 2004 ± Health Sector Reform Agenda of the Philippines was launched 2005 ± Fourmula One for Health to ensure speed. redirecting the function and operations of the DOH.   May 24.

(Freeman) .Definitions and Focus: PHN/CHN  Both term are often interchange but synonymous  PHN is a synthesis of public and nursing practice.

 PHN is a field of professional practice in nursing and in public health in which technical nursing. analytical and organizational skills are applied to problems of health as they affect community. . interpersonal.

through comprehensive nursing care of families and other groups and through measures for evaluation or control of threats to health. . for health education of the public and for mobilization of the public for health action.These skills are applied in concert with those of other persons engaged in health care.

prolonging life. control of communicable diseases.E.  . WINSLOW  PUBLIC HEALTH ± is the science and art of preventing disease. education of individuals in personal hygiene«. promoting health and efficiency through organized community effort for the sanitations of the environment. C.Public Health According to Dr.

and the development of the social machinery to ensure everyone a standard of leaving adequate for the maintenance of health. so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.« the organization of medical and nursing services for early diagnosis and preventive treatment of disease. .

 .According to WHO  PUBLIC HEALTH ± is the art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greater number.

 Therefore. the core element of governments¶ attempts to improve and promote the health and welfare of their citizens. .

 Core business of PUBLIC HEALTH Disease control  Injury prevention  Health promotion  Healthy public policy. in relation to environmental hazards  Promotion of health and equitable health gain  .

Essential Public Health Functions Health situation monitoring and analysis  Epidemiological surveillance/disease prevention and control  Development of policies and planning in public health  Strategic management of health systems and services for population health gain  Regulation and enforcement to protect public health  .

social participation and empowerment  Ensuring the quality of personal and population based health services  Research.Human resources development and planning in public health  Health promotion. development and implementation of innovative public health solutions  .

 .Public Health Nursing Made great contributions to the improvement of the health of the people  Leaders in providing quality health care services to communities.  First level of health workers to be knowledgeable about new public health technologies and methodologies.  Usually the first to be trained to implement new programs and apply new technology.

O  Demarcates the line of nursing action To serve both well and ill in the community  Right to medical care and right to nursing care are implied in the fundamental human rights   A changing trend in community care gave birth to COMMUNITY HEALTH NURSING .H.NURSING UNDER W.

Jacobson. prevention disease and disability and rehabilitation  Achieved through teaching and delivery of health care   GOAL: raise the level of health of the citizenry .Community Health Nursing  Maglaya. Freeman Utilization of nursing process for clientele  Concerned with the promotion of health (optimal level of functioning).

Margaret Shetland)  Base on the worth and dignity of human Historical background (refer to pp 8816) . Philosophy (Dr.

Basic Concept of CHN Primary focus on health promotion and disease prevention  Extend the benefits not only to individual but the whole family and community and special population  CH nurse are generalist in terms of their practice from womb to tomb  .

social and other related sciences Continuous nursing process is applied . Contact with clients is a long term at all levels of health care    PHC (community) SHC (regional/provincial/district municipal/local hosp.) THC (sophisticated medical centers)   CHN practice requires knowledge from biological.

Basic Principles of CHN Recognized needs of communities. families. groups and individuals  CHN nurses has full knowledge of the objective and policies of the agency she represent (facilities goal achievements)  Set priorities  Goal setting  Objective should be client centered and SMART  Action  Evaluation  .

customs and beliefs of client  Health education and counseling are vital role of CHN  Collaborative work relationshiprelationshipcoordinator of health service  .Focus care on the family  Available to all race. creed and sociosocioeconomic status and respect values.

Monitoring or periodic evaluation of health services (accurate recording and reporting for evaluation purposes)  Opportunities of continuous education program to upgrade nursing practice  Make use of available community health resources or the indigenous and existing community resource appropriate technology  CH nurse has active participation in the community  .

.Role of Public Health Nurse  The roles are varied and dynamic. specific goals of the health care system and the attitudes and practices of the nurse in providing care.  It is influenced by the nature of health needs of the population.

 Clinician (health care provider) ± takes care of sick people at home or in the RHU.  Home visit  PHN Bag .

Home visit  PURPOSE Give nursing care to sick. mothers. and children  Assess living condition  Provide health education  Promote health and use of referral for utilization of community health  .

 PRINCIPLE State purpose and objective  Use records and reports  Give priority to essential needs  Planning and delivery of care involves clients  Plan should be flexible  .

PHN Bag  Essential and indispensable equipment which contains basic medication and articles necessary for giving care.  Should observe proper bag technique principle  Prevent spread of microorganism  Save time and efforts for nursing procedure  Should show effectiveness of total care given to clients .

 Case Manager  Assist clients to make decisions about appropriate health care services and to achieve service delivery integration and coordination .

lobby for beneficial public policy and stimulate supportive community action for health . Advocate  Seek to promote an understanding of health problems.

 Teacher/Health  Application Educator of teaching ± learning principles to facilitate behavioral changes among clients .

sociosocio-civic organizations and sectoral groups . Partner/  To Collaborator get people together in order to address problems or concerns  Works with people¶s and health organizations educational institutions.

 Health Planner/Programmer Identifies needs. memoranda and circulars for the concerned staff/personnel and provide technical assistance  . priority and problems of individual. families and communities  Formulates nursing component of health plans  Interprets and implements nursing plans. program policies.

organizing. implementing and evaluating health programs and services . Community  Responsible Organizer/Leader for motivating and enhancing community participations in terms of planning.

 Case Finder/Epidemiologist  Looks for actual or risk problems or concerns and followed periodically as they develop .

accurate and complete recording and reporting . Recorder  Prepares and Reporter and submit required records and report  Review. validates. analyzes and interprets all records and reports  Maintains adequate. consolidates.

Responsibility of CHN Be a part in developing and overall health plan.  Provide quality nursing service to all level of clientele  Maintain coordination/ linkages with other health team members in the provision of public health service  . its implementation and evaluation for communities.

Conduct researches relevant to CHN services to improve provision of HC  Provide opportunities for professional growth and continuing education for staff development  .


1946) .CONCEPTS AND DEFINITIONS  Health is a state of complete physical. mental and social wellwellbeing and not merely the absence of disease or infirmity (WHO.

 All people should have access to basic resources for health:   Peace.A fundamental human right (Ottawa Charter ± 1986). . food and shelter. and a stable ecosystem and sustainable resources use. adequate resources.


Medical Model   Health is the state of being free of signs or symptoms of disease and illness.  . The absence of one or more of the ³five D¶s´ Death Discomfort Disease Disability Dissatisfaction * If you are not sick or dying. you are considered to be in the best attainable state of health.

Health Belief Model  Health and illness is affected by genetic characteristics and the cultural values and beliefs learned and practice by the families and communities. Beliefs ± Feeling ± Behavior .

is useful for examining the cause of disease in an individual.hostenvironment model of health and illness for community health (Leavell and Clark ± 1965).hostagent.Agent ± Host ± Environment Model  The agent.. .

³health is an ever changing state.´ ENVIRONMENT (factors external to the host) AGENT (microorganism or chemical substance) HOST (living organism capable of being infected by the agent) .

HealthHealth.Illness Continuum  Health is a constantly changing state. . or continuum. with high level wellness and death being on opposite ends of a graduated scale.

. Rodale).High Level Wellness  High level wellness refers to functioning to one¶s maximum potential while maintaining balance of purposeful direction in the environment(1977.

Needs Fulfillment Model  Health is a state in which needs are being sufficiently met to allow an individual to function successfully in life with the ability to achieve the highest possible potential .

.Role Performance Model  Health is the ability to perform all those roles for which on has been socialized.


and a range of approaches for addressing priority health needs and the fundamental determinants of health. the Declaration of Alma-Ata Almaarticulated primary health care as a set of guiding values for health development. . a set of principles for the organization of health services. 30 years ago.

 The Declaration of Alma-Ata was Almaadopted at the International Conference on Primary Health Care. 6- . 1978. September 6-12. Alma-Ata). presently in Kazakhstan. Almaty (formerly Alma-Ata).

 It expressed the need for urgent action by all governments. all health and development workers. . and the world community to protect and promote the health of all the people of the world.

. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of WHO as the key to achieving the goal of "Health for All".

Primary health care. is  "essential health care based on practical. scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of selfselfdetermination" . often care. abbreviated as PHC.

which was signed by former President Marcos on October 19. . In the Philippines. 1979. primary health care was implemented under Letter Of Instruction 949 .

MISSION  To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care .

Framework  People¶s empowerment and partnership is the key strategy to achieve the goal ³Health for all Filipinos and Health in the hands of the people by the year 2020´.  .GOAL Health for All  SELF-RELIANCE SELF  ability to stand on their own self-sufficiency self In accordance with the goal of the Department of Health which is.




Convergence (meeting) of health, food, nutrition, water, sanitation, and population services. Integration of PHC into national, regional, provincial, municipal and barangay development plans.


of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services.  Establishment of effective health referral system


Health services delivered where the people are Use of indigenous volunteer health worker as a health provider with a ratio of one community health worker per 10-20 10households Use of traditional medicines with essential drugs


Awareness building and consciousness rising on health- related issues. healthPlanning, implementations, monitoring and evaluation done through small group meeting (10-20 household cluster) (10-

Selection of community health workers by the community.  Formation of health committees.  Establishment of community health organization at the parish or municipal level.  Mass health campaigns and mobilization to combat health problems 


Use of local resources Training of community in leadership and management skills Incorporation of income generating projects, cooperatives and small scale industries.

education.SOCIAL MOBILIZATION     Establishment of an effective health referral system MultiMulti-sectoral and interdisciplinary linkage Information. communication support using multi-media multiCollaboration between government and nonnongovernment organizations .

.DECENTRALIZATION      Devolution (RA 7160) Transfer of power from the national government to local government unit Reallocation of budgetary resources Reorientation of health professionals on Primary Health Care Advocacy for political will and support from the national leadership down to the barangay level.

PROVISION OF QUALITY. preventive. curative and rehabilitative health care Regular monitoring and periodic evaluation of community health worker performance by the community and health staff. knowledge and skills developed are on promotive. BASIC AND ESSENTIAL HEALTH SERVICES    Training design and curriculum based on community needs and priorities Attitude. .

that health is a basic right of every individual and not just to those who can afford to pay their own health care . Use of Appropriate Technology  This emphasizes equity and justice.MAJOR ELEMENTS 1.

appropriate Acceptability Feasibility ± compatible with the local setting .       Criteria in determining use of appropriate technology Effectiveness and safety Complexity ± simple and easy to apply Cost Scope of technology ± effective.

physical conditions) . economic.2. Multi-Sectoral Approach to Health Multi- Other health related systems (private/government) Ways of the People (knowledge and values) Community Heath Health Care System Environmental (social.

it is necessary to unify health efforts within the health organization it self and with other sectors concerned. As such. . It implies the integration of health plans with the plan for the total community development.Intersectional Linkages  Primary Health Care forms an integral part of the health system and the over all social and economic development of the community.

 Sectors most closely related to health includes those concerned with:  Agricultural  Education  Public works  Local government  Social welfare  Population control  Private sectors .

the acceptance or primary health care necessitates the restructuring of the health system to broaden health coverage and make health service available to all. . Primary care is the hub of the health system. There is now widely accepted pyramidal organization that provides level of services starting with primary health and progressing to specialty care.Intrasectoral Linkage  In the health sector.

/Health Centers Private Practitioners. Community Hosp. Medical Centers. Teaching & Training Hospitals Provincial/City Health services and Hospitals Emergency and District Hospitals Rural Health Units. Barangay Health Station .National & Regional Health Services.

large industrial firms for their employees Community hospitals and health centers operated by Philippine Medical care Commission and other health facilities operated by voluntary religious and civic groups Health services offered: caters to individuals in fair health and to patients with disease in the early symptomatic stages. chest subclinics. their sub-centers. . malaria eradication units operated by the DOH Private clinics operated by Philippine medical Association.HEALTH CARE FACILITIES  1. Primary Level of Health Care Facilities     This are the rural health units.

nonnondepartmentalized hospitals including emergency and regional hospitals.HEALTH CARE FACILITIES  2.  Health services offered: care for patients with symptomatic stage of disease with requires moderately specialized knowledge and technical resources for adequate treatment. Secondary Level of Health Care Facilities  These are smaller. .

 3.  Health services offered: for clients afflicted with diseases which seriously threaten their health and which requires highly technical and specialized knowledge.  . These are specialized national hospital. facilities and personnel to treat effectively. Tertiary Level of health Care Facilities These are highly technological and sophisticated services offered by medical centers and large hospitals.

Two way referral system 2 H E A L T H F A C I L I T I E S 3 H E A L T H F A C I L I T I E S Barangay Health Worker Public Health Nurse Barangay Health Stations Rural Health Unit Midwifes Physician Barangay Health Midwifes Sanitary Inspector .

PRIMARY HEALTH WORKER  Village/Grassroots Train community health workers. health auxiliary volunteers. TBA  1st contact of the community (initial link)  Work in liaison with local health service worker  Provide elementary. curative preventive health care measures  .

training. referral services and supplies through linkages with other sectors  .Intermediate level  General Medical Practitioners. PHN. Midwifes  1st source of professional health care  Attend to health problems beyond the competencies of the village workers  Provides support to the front line health workers in term of supervision.

 Provide back-up health services for cases backrequiring hospital or diagnostic facilities not available in health care  .Health Personnel of first line hospitals  Physicians with specialty area. nurses and dentists  Establish close contact with the village and intermediate level health workers to promote the continuity of care from hospital to community to home.

3. Community participation Defining their health and health related needs and problems  Identifying realistic solution  Organizing community health action  Mobilizing local resources  Providing essential health services  Evaluating the results of health actions  .

ELEMENTS OF PRIMARY HEALTH CARE H ± Hospital as a Center of Wellness  O ± Oral and Dental Health  M ± Mental Health  E ± Elderly Care .

        E L E M E N T S ± Education for Health ± Locally Endemic Disease Control ± Expanded program on Immunization ± Maternal and Child Health ± Essential Drugs ± Nutrition ± Treatment of Communicable Diseases ± Safe water and Sanitation .

WHO (1986) Ottawa Charter  Participation is essential to sustain health promotion action  .HEALTH PROMOTION Health promotion is a process of enabling people to increase control over the determinants of health and thereby improve their health.

and  Mediating between the different interests in society in the pursuit of health  .STRATEGIES FOR HEALTH PROMOTION Advocacy for health to create the essential conditions for health.  Enabling all people to achieve their full health potentials.

1996) Individual characteristics and experiences can be useful in predicting if an individual will incorporate and use health related behaviors.´  .Health Promotion Model (Nola Pender. it is more likely to used again.  ³ If a behavior has been used before and becomes a habit.

 BehaviorBehavior. A health related behavior is initiated by committing to a plan of action. accompanied by developing associated strategies to perform the value behavior. beliefs and relationships ± major motivators for engaging in health behaviors.  .specific knowledge.

HEALTH PROMOTION MODEL (HPM) ± NOLA PENDER  Conceptualized that motivation to participate in health promoting behavior is influenced by cognitive-perceptual factors cognitiveand modifying factors  .

COGNITIVE-PERCEPTUAL COGNITIVEFACTORS INCLUDES:        Importance of health Perceived control of health Self efficacy Definition of health Perceived health status Perceived benefits of health promoting behaviors Perceived barriers to health promoting behaviors .


whereas a person with low selfself-efficacy would harbor feelings of hopelessness. .  Example:   A person with high self-efficacy may engage selfin a more health related activity when an illness occurs.SelfSelf-efficacy It is a belief that one has the capabilities to execute the courses of actions required to manage prospective situations.

 Therefore: Self efficacy is the ability or the power to produce an effect/ change. .

 . tasks. and challenges.  One's sense of self-efficacy can play a selfmajor role in how one approaches goals.Psychologist Albert Bandura has defined selfself-efficacy as one's belief in one's ability to succeed in specific situations.

 According to Bandura's theory. people with high self-efficacy: selfare those who believe they can perform well  are more likely to view difficult tasks as something to be mastered rather than something to be avoided.  .

but will engage in tasks where their selfself-efficacy is high. People generally avoid tasks where their self-efficacy selfis low.How self-efficacy affects human selffunction  Choices regarding behavior  People will be more inclined to take on a task if they believe they can succeed. .

than those with low efficacy. Motivation  People with high self-efficacy in a task are selfmore likely to make more of an effort. and persist longer. .

 .  People with high self-efficacy often take a selfwider overview of a task in order to take the best route of action. Thought patterns & responses Low self-efficacy can lead people to believe selftasks are harder than they actually are.

 Self-efficacy also affects how people respond Selfto failure.  . where a person with low self-efficacy will attribute failure to selflow ability.  A person with a high self-efficacy will attribute selfthe failure to external factors.People with high self-efficacy are shown to be selfencouraged by obstacles to make a greater effort.

condom use. seat belt use. Health Behaviors  Health behaviors such as non-smoking. nonphysical exercise. dental hygiene. dieting. . dependent on one¶s level of perceived self-efficacy (Conner self& Norman. among others. 2005). or breast selfselfexamination are.

 .SelfSelf-efficacy beliefs are cognitions that determine whether health behavior change will be initiated.  Self-efficacy influences the effort one puts Selfforth to change risk behavior and the persistence to continue striving despite barriers and setbacks that may undermine motivation. how much effort will be expended. and how long it will be sustained in the face of obstacles and failures.

" or "I intend to quit smoking altogether"). 2005).g. "I intend to reduce my smoking.. & Schwarzer.  SelfSelf-efficacy is directly related to health behavior. A number of studies on the adoption of health practices have measured selfselfefficacy to assess its potential influences in initiating behavior change (Luszczynska. . but it also affects health behaviors indirectly through its impact on goals. SelfSelf-efficacy influences the challenges that people take on as well as how high they set their goals (e.

the benefits of changing that behavior and the improvement of quality of life .TYPES OF HEALTH PROMOTIONAL ACTIVITIES  HEALTH EDUCATION (information dissemination)  Use of variety of media to offer information to the public about the particular lifestyle choices and personal behavior.

FIVE PRIORITY ACTIONS AREA Build healthy public policy.  Strengthen community action for health.  Developed personal skills.  Create supportive environments for health.  Re-orient health services Re .

Jakarta Declaration on Leading Health Promotion into the 21st Century (1997) .

Strategies and action areas are relevant for all countries Comprehensive approaches to health development are most effective.  .  Health literacy fosters participations.  Setting for health offer practical opportunities for the implementation of comprehensive strategies.  Participation is essential to sustain efforts.

development.  Expand partnerships for health promotion.  Increase investments for health development.  Increase community capacity and empower the individuals. promotion. individuals. health.  Secure an infrastructures for health promotion  .Five Priorities Promote social responsibility for health.

ACTIVITIES FOR HEALTH PROMOTION  HEALTH APPRAISAL WELLNESS ASSESSMENT PROGRAM Appraise individuals of their risk factors that are inherited in their lives/family in order to motivate them to reduce specific risk and develop positive health habits  Wellness assessment programs are focused on more positive methods of enhancement  .

 LIFE-STYLE AND BEHAVIOR CHANGE LIFEPROGRAM Basis for changing behavior  Geared towards enhancing the quality of life and extending the life span  .

 WORKSITE WELLNESS PROGRAM  Includes programs that serve the needs of the persons in their work places .

. ENVIRONMENTAL CONTROL PROGRAM  Developed to address the growing problem of environment pollution such as air. water etc. land.

DISEASE PREVENTION  Disease prevention covers measures not only to prevent the occurrence of diseases. WHO (1984) . such as risk factor reduction. but also to arrest it progress and reduce its consequences once established.

Disease prevention is sometimes used as a complementary term alongside health promotion.  .  Although there is frequent overlap between the content and strategies. disease prevention is defined saparetly.

dealing with individuals and populations identified as exhibiting identifiable risk factors. . often associated with different risk behaviors. Disease prevention is considered to be actions which usually emanates from health sector.

 Decreases the risk or exposure of individual and community to disease.LEVELS OF DISEASE PREVENTION PRIMARY LEVEL  Directed towards preventing the initial occurrence of disease.   Example:  Health education about accident and poisoning .

 Immunization  Risk assessments for specific disease  Family planning services and family counseling  Environmental sanitation and provision of adequate housing. exercise requirements. stress management. protection against occupational hazard. Health education about standards of nutrition and growth and development. recreation and work conditions .

 Includes prevention of complications and disabilities.SECONDARY LEVEL  Focus on early identification of health problem and prompt intervention to alleviate health problems.   Example  Screening surveys .

turning. Encouraging regular medical and dental examination  Teaching self-examination for breast and testicular selfcancer  Assessing growth and development of children  Maintaining skin integrity. elimination. administering medical therapies such as medications . food and fluid intake. exercising client. positioning. ensuring adequate rest and sleep.

TERTIARY LEVEL  Begins after illness. when defect or disability is fixed or determined to be irreversible  Focus to help rehabilitate individuals and restore hem to an optimal level of functioning within the constraints of the disability  .

 Example:  Referring client to a support group  Teaching diabetic client to prevent complications  Referring client to rehabilitation center .

BAHAVIOR ASSOCIATED WITH LEVELS OF PREVENTION  PRIMARY Quit smoking and avoid alcohol intake  Regular exercise and eat well balance diet  Reduce fat and increase fiber intake  Take adequate fluid intake  Maintain ideal body weight  Complete immunization program  Avoid over exposure to sunlight and wear protective gear at work place  .

o. and above  . SECONDARY Have annual health examination  Regular pap¶s test for women  Monthly BSE for women (20 and up)  Sputum examination for tuberculosis  Anal stool guaiac test and rectal examination for client 50 y.

 TERTIARY Self monitoring of blood glucose among diabetic client  Physical therapy after CVA  Participate in cardiac rehabilitation after MI  .


(Maglaya. sociocontext. 2004) 2004)  .COMMUNITY Comunitas ± latin word for group of individuals  A community is a group of people sharing common geographical boundaries and/or common values and interest/ its functions within a particular socio-cultural context.

belonging. (Spradley & Allender. 1996) 1996) . A community is a collection of people who interact with each other and whose common interest or characteristics give them a sense of unity and belonging.

Dimensions of a Community LOCATION  POPULATION  SOCIAL SYSTEM  .

boundary of the community placement of health services geographical features climate plants and animal (ecosystem) humanhuman-made environment . 2. 4. 3. 5. 6.LOCATION 1.

POPULATION 1. 4. 2. size density composition\ composition\rate of growth and decline cultural characteristics social class mobility . 6. 3. 5.

SOCIAL SYSTEM      health family economic education region      welfare political recreational legal communication .

URBAN  .Classifications of a community URBAN  RURAL  SUB .

URBAN       city high density area socially heterogeneous population complex structure complex interpersonal social relations nonnon-agricultural occupation .

province low density area having simple life close family ties people usually spend time in farming and fishing for foods .RURAL      town .

URBAN     suburbs a combination of an urban and rural community thick population heterogeneous with mixed family ties .SUB .

Cultural activities 8. popularity 5. wide scale institution. Size 11. more membership Paid services Few White color jobs. less in membership. professionals Few Generally big Based on educational attainment. Domestic animals 10. Choice . few are rich and majority of the people belong to a lower income Highly specialized. Nature of occupation 9. Social institution Not very specialized. Social mobility 4. credentials. achievements. small scale institution Bayanihan is common Many Agricultural/ non professional Many Usually small Based on personal attachment 6. Activities 7. Social structure Greater There is very wide range of income distribution. Social relationship Less dense Strong and have close ties and interaction with the community Lesser No significant difference of wealth.Difference between Rural and Urban Community Criteria 1. Density of population 2. more or less there is even distribution of wealth Rural Thick dense Face to face contact but usually very casual Urban 3.

 achieve a working consensus on the agreedagreed-on goals.  collaborate effectively in the required actions  . concerns and problems of the community.HEALTHY COMMUNITY A community which is able to:  collaborate effectively to identify the needs.

values openly recognize the existence of subgroups and welcome their participation prepared to meet crises .CHARACTERISTIC OF A HEALTHY COMMUNITY prompts its members to a degree of awareness uses its natural resources eg. eg. air to breath. cooperation.

able to solve problems has an open channel of communication seek to make its system of community resources are available for all encourage maximum participation in decision making promotes high level of wellness .

Components of a Community Core  Sub system  .

CORE  represents the people that make up the community Social class  Ethnicity  Culture  Beliefs  Traditions  .


materials. arrangement Are there enough housing facilities available?  Are there housing laws/regulations governing the people?  .HOUSING  What type of housing facilities are there in the community?  Structure.

regulations.  Ratio of health educators to learners. facilities.EDUCATION These include laws. and activities affecting educations. educations. distribution of educational facilities  .

and the distribution of these in the community.  Peace and order  .FIRE AND SAFETY Fire protection facilities and fire prevention activities.

. etc.POLITICS AND GOVERNANCE  Political structure presents in the community. decision making process/ patterns leadership style observed etc.

programs.HEALTH  Health facilities and activities present. utilization. distribution. ratio of providers to clientele served. . and priorities in health programs.

types of communication. forms of communication be it formal or informal etc. existing. .COMMUNICATION  Systems. etc.

ECONOMICS  Occupation. types of economic activities. and income. . etc.

RECREATION Recreational activities and facilities  Type of consumers.  . consumers.

care.  People work together to attain goals.  Safe water and nutritious food  Families provide members with basic needs  Available. accessible. safety.  Physical environments promote health. order and cleanliness. goals. affordable. cleanliness.Elements of a Healthy Community People are partners in health care. acceptable health care services  .

a stable ecosystem. sustainable resources. shelter. social justice and equity.Community Health  According to Dever :  fundamental to community health are peace. education. . equity. income. food.

action and healthy pubic policies are essential to healthy community. According to Flynn: Flynn:  responsibility for health is widely shared in the community with collaborative decisiondecisionmaking about health issue. Informed political issue. . community.

consumer satisfaction. crime rates. functional levels. mental health. .morbidity. risk factors. and infant mortality. STATUS DIMENSION . According to Geoppinger: Geoppinger:  community health have 3 dimensions that are currently assessed by multiple measures: measures:  1. life expectancy. mortality. mortality.

. socio-economic and racial sociocontribution and education. population rates. STRUCTURAL DIMENSION community resources measured by utilization patterns. education. social indicators measured by dependency ratios. treatment data and providers. 2.

articulateness.effective community functioning that results in community competence as evidence by: by: commitment. society. 3. self-awareness and ability selfof situational definitions. PROCESS DIMENSION . and accommodation. . conflict. effective communication. participation and management of relations with large society.


Rehabilitative FACTOR AFFECTING HEALTH . Preventive Curative.POLITICAL Safety Oppression People SOCIO ECONOMIC Employment Education. water Noise Radiation Empowerment BEHAVIOR Culture Habits Norms Ethnic Customs HEREDITY Genetic -defects -risks familial ethnic racial OLOF Individuals Family Community HEALTH CARE DELIVERY SYSTEM Promotive. Housing ENVIRONMENT Air Food.

environment. power and authority to regulate the environment. health. differential treatment in various classes of society affects health. Oppression especially of society. Examples are safety. Increase in crimes and the lack of safety in streets and even in homes are major concerns of society. the poor. empowerment. Political jurisdictions have the live.POLITICAL  Politics greatly influence the social climate in which people live. . oppression and people empowerment.

SOCIOSOCIO-ECONOMIC  Families from the lower income groups are the ones mostly served in public health services and by the community health workers. the middle and upper income group have also very pressing health problems such as drug abuse and lifelifestyle diseases. However. people from the lower income groups tent to have proportionately greater number of illnesses and health problems than those in the higher income groups. This is because. .

HEREDITARY  Understanding of genetically influenced diseases is increased through knowledge about the nature of the genetic materials and about the process by which genetic traits are transmitted. the genetic risk makes it possible to anticipate and counteract genetic outcomes thus enabling the medical team to prepare for necessary therapeutic intervention. Early knowledge of transmitted. intervention. .

ENVIRONMENT  The menace of pollution has been growing over the years and has greatly affected the health of the people. The diseases today people. made. . are largely man made.

. substance abuse and lack of exercise.BEHAVIORS/ ATTITUDE/LIFE-STYLE ATTITUDE/LIFE A person¶s level of functioning is affected by certain habits that he has. be in form of smoking. heritage. intake of alcoholic drinks. to a large extent. These may has. health care and child rearing practices are shaped. The people¶s lifestyle. exercise. by their culture and ethic heritage.

affordable. Philippines.HEALTH CARE DELIVERY SYSTEM  HEALTH CARE DELIVERY SYSTEM. Although promotive and preventive health measures are emphasized in community health the availability and accessibility of curative and rehabilitative services also affect people¶s health. acceptable. . primary health care is a partnership approach to the effective provision of essential health services that are community based. health. In the SYSTEM. sustainable and affordable. accessible.


´  .´  WHO defined health as ³A complete state of mental. and social well-being welland not merely the absence of disease or infirmity. DEVELOPMENT WHO defined community as ³ A social group determined by geographical boundaries and/or common values and interests. HEALTH. physical.COMMUNITY.

Development is defined as: 

a change, a process of unfolding from an ununmanifested condition to more advance or effective condition. In these process the qualities reveals possibilities, capabilities emerge, and potentials are realized.

A multi-dimensional process involving major multichanges in social structures, population, attitudes and national institutions, as well as the acceleration of economic growth, reduction of inequality and eradication of absolute poverty.  The goal of development is to have a better life. (Teodoro, 1978) 

According to NEDA: Development includes consumption of basic goods and services such as health and education and the generation of more productive employment and reduction of inequalities in income and access.

Community Development 

is a process designed to create a condition of economic and social progress for the whole community with its active participation and fullest possible reliance on the community initiatives.

This is achieved through:
Democratic procedures  Voluntary cooperation  Self-help Self Development of indigenous leadership  Education 

How can we say that the community is developed?
the people are working together  have the vision  know how  capabilities and experience to confront and solve problems of under development 

reliance. the health of the community depends on its ability to work toward common health goals and upon adequate distribution of health resources to all members.  Community development principle is committed to the services of the people to become selfselfreliance. Therefore. .

 Furthermore. Organized community effort to prevent disease and promote health is valuable and effective. .


WELFARE APPROACH   This is an immediate and/or spontaneous response to ameliorate the manifestation of poverty. especially on the personal level. . natural disasters and certain circumstances. which are beyond the control of the people. Assumes that poverty is caused by bad luck.

Introduces whatever resources are lacking in a given community. .MODERNIZATION APPROACH    This is also referred to as the project development approach. Also considered a national strategy. which adopts the western mode of technological development.

lack of resources such as capital and technology.Assumes that development consists of abandoning the traditional methods of doing things and must adopt the technology of industrial countries.  Believes that poverty is due to lack of education.  .

.TRANSFORMATORY/ PARTICIPATORY APPROACH  This is the process of empowering/ transforming the poor and the oppressed sectors of society so that they can pursue a more just and humane society.

oppression. domination and other unjust structure. . Believes that poverty is caused by prevalence of exploitation.


 A social development approach that aims to transform the apathetic. individualistic. and voiceless poor into a dynamic. participatory and politically responsive community. .

 A collective. . participatory. sustained and systematic process of building people organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards affecting change in their existing oppressive and exploitative conditions. transformative. liberated.

Develops objective. . confidence to take action in respect to them and in doing so extends and develops cooperative attitudes and practices in the community. A process by which community identifies its need and objective.

 A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition. collectively and efficiently on their immediate and long term problems. . and mobilizing the pursue to develop their capability and readiness to respond and take action on their immediate needs toward solving their long term problems. working with the people.

as this helps the community workers to generate community participation and developmental activities.IMPORTANCE OF COPAR  COPAR ± is an important tool for community development and people empowerment. .

 COPAR ± prepares people/clients to actually takeover the management of development programs in the future. .

. community resources are mobilized for community services. COPAR ± maximizes community participation and involvement.

COPAR should be based on the interest of the poorest sectors. . exploited and deprived sectors are open to change. COPAR should lead to self-reliant community selfand society. and able to bring about change. have the capacity to change.PRICIPLES OF COPAR    People especially the most oppressed.

. local. and concrete issues identified by the people and the evaluation and reflection of actions taken by them.PROCESSES AND METHODS USED  A PROGRESSIVE CYCLE OF ACTIONACTIONREFLECTION-ACTION (ARA) ± which REFLECTIONARA) begins with small.

 CONSCIOUSNESS RISING ± through experiential learning is centered to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. .

the powerless and the oppressed. PARTICIPATORY AND MASS BASED ± it is primary directed towards and based in favor of the poor. .

. emerged and are tested through action rather than appointed or reelected by some external force or entity. GROUP CENTERED AND NOT LEADER ORIENTED ± leaders are identified.


PREPRE-ENTRY PHASE   The initial phase of the organizing process where the community organizer looks for communities to serve or help. . activities and strategies and time spent for it. It is considered the simplest phase in terms of actual outputs.

 Preparing the health care worker. Activities included:  Designing a plan for community development. . including all its activities and strategies for care and development.

 Designing     criteria for the selection of site Depressed Oppressed Poor Exploited  Actual selecting the site for community care .


Sometimes called the social preparation phase This includes the synthesis of the people on the critical events in their life, motivating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to make collective action on these.

NOTE:  Recognize the role of local authorities by paying them visits to inform them of their presence and activities.  Health worker appearance, speech, behavior and lifestyle should be in kept in low profile and health workers should always serves as a role model.  Avoid raising the consciousness of the community residents  Work always with community member to identify potential leaders.

This phase signals the actual entry of the community worker/organizer into the community. She must be guided by the following: 

Integration with the community Conduct of courtesy calls Conduct of information campaigns about the community health development programs Conduct of the community study and social investigation Provision of health and health related services, and Identification of potential leaders

NOTE:  Recognize the role of local authorities by paying them visits to inform them of their presence and activities.  Health worker appearance, speech, behavior and lifestyle should be in kept in low profile and health workers should always serves as a role model.  Avoid raising the consciousness of the community residents  Work always with community member to identify potential leaders.


Once the community health nurse identifies the potential leaders, they were formed into a core group. The core group will be given the role of community organizer. 

Integration with the core group members Deepening social investigation Training and education Mobilizing the core group


Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementing, and evaluating communitycommunity-wide activities.

. knowledge and skills) in managing their own concerns/programs. It is at this phase where the organized leaders or groups are being given trainings (formal. informal) to develop their ASK (attitude.

 Other community members are encourage to join and form a community organization  Pre-organization Pre- building activities  Organizing the barrio health committee  Setting up community organization  Training and education for the organization .

.SUSTENANCE AND STRENGTHENING PHASE  Occur when the community organization has already been established and the communitycommunity-wide undertakings.

the different committees setsetup in the organization-building phase are organizationalready expected to be functioning by way of planning. At this point. . implementing and evaluating their own programs. with the overall guidance from the community-widecommunity-wideorganization.

. Strategies used:  Education and training  Networking and linking  Conduct of mobilization on health and development concerns  Implementation of livelihood projects  Developing secondary leaders.


 . history.CRITICAL STEPS IN BUILDING PEOPLE ORGANIZATION  INTEGRATION ± a community organizer becoming one with the people in order to: immerse himself in the poor community  understand deeply the culture. rhythms and lifestyle of the community. leaders. economy.

analyzing data to draw a clear picture of the community. SOCIAL INVESTIGATION ± A systematic process of collecting. Also known as community study . collating.

 TENTATIVE PROGRAM PLANNING ± Community organizer to choose one issue to work on in order to begin organizing the people. .

A time to spot and develop potential leader. The entry phase or sometimes called the social preparation phase. GROUNDWORK ± Going around and motivating the people on something or an issues. .

. People collectively ratifying what they have already decided individually. MEETING ± Core group formation. The meeting gives the people the collective power and confidence. Problems and issues are discussed.

 ROLE PLAYING ± To act out the meeting that will take place between the leaders of the people and the government representatives. .

 MOBILIZATION OF ACTIONS ± Actual experience of the people in confronting the powerful and the actual exercise power. .

 . REFLECTION ± dealing with deeper. onongoing concerns to look at the positive values compared to the ideal. EVALUATION ± determines whether the goal is met or not.

Occurs when the community organization has already been established and the community members are already participating in a community wide undertaking. ORGANIZATION ± the result of many successive and similar actions of the people. .


Assessment of Community Health Needs  Community Diagnosis  A process by which the nurse collects data about the community in order to identify factors which may influence the illness and deaths of the population.  To formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies. .

Steps involved: Site selection  Preparation of the community  Statement of the objectives  Determine the data to be collected  Identify methods and instruments for data collection  Finalize sampling design and methods  Make time table  .

Population group  Vulnerable groups Infants and young children  School age  Adolescents  Mothers  Male  Old people  .

Implementation Phase Data collection  Data organization/collation  Data preparation  Data analysis  Identification of health problems  Prioritization of health problems  Development of health care plan  Validation and feedback  .

Health status problem ± they may be described in terms of increased or decreased morbidity. materials or institutions necessary to solve health problem . Health resources problems ± they may be describe in terms of lack or absence of manpower. mortality or fertility B.Community health problems are categorized as: A. money.

economic.c. Health related problems ± they may be described in terms of existence of social. environmental and political factors that aggravate the illnessillnessinducing situation in the community .

Priority Setting  Criteria:      nature of the problem presented ±the problems are classified by the nurse as health status. controlling or eradicating the problem preventive potential ± this refers to the probability of controlling or reducing the effects posed by the problem social concern ± this refers to the perception of the population or the community as they are affected by the problem . health resources or health related problems magnitude of the problem ± this refers to the severity of the problem which can be measured in terms of the proportion of the population affected by the problem modifiability of the problem ± this refers to the probability of reducing.

49% affected < 25% affected Modifiability of the problem High 3 Moderate 2 Low 1 Not modifiable 0 Preventive potential High 3 Moderate 2 Low 1 Social concern Urgent community concern Recognized as problem but not needing urgent attention Not a community concern 2 1 0 4 3 2 1 Weight 1 3 4 1 1 .100% affected 50% .74% affected 25% .Criteria Nature of the problem Health status 3 Health resources 2 Health related 1 Magnitude of the problem 75% .

Community Goal of Care Assessment Planning nursing action needs Establish goal base on needs and capabilities of staff Construct action and operation plan Develop evaluation parameters Revise plan as necessary Prioritize Implementation of plan of care Put Evaluation of care and services rendered audit Care outcomes Performance appraisal Estimate cost benefit ratio Assessment of problems Identify needed alterations Revise plan as necessary Nursing contact Demonstrate caring attitudes mutual trust and confidence Collect data from all possible sources iIentify health problems Assess coping ability Analyze and interpret data Initiate nursing plan into action Coordinate care/services Utilize community resources Delegate Supervise/monitor health services provided Provide health education and training Document responses to nursing care .Individual. Family.


Biostatistics  Demography Study of population size. composition and spatial distribution as affected by births and deaths and migration. .

 Sources  Census ± complete enumeration of the population  De jure ±people were assigned to place where they usually live regardless of where they are at the time of the census  De facto ±people were assigned to place where they physically present at the time of the census .

Components Population Size  Population Composition  Age distribution  Sex ratio  Population pyramid  .

Economic group. Median age  Age dependency ratio  Other characteristics  Occupational groups. Ethnic group . Educational attainment.

Population Distribution Urban ± Rural  Crowding Index ± indicates the ease by which a communicable disease can be transmitted from one host to another susceptible host  Population Density ± determine the congestion of the area/place  .

Vital statistics  The application of statistical measurements to vital events such as births.  Fertility rate  Crude birth rate  General fertility rate . deaths and common illness that is utilized to gauge the levels of health. illness and health services of a community.

 Mortality rates        Morbidity rates   CDR Specific mortality rates Infant mortality rate Neonatal mortality rate PostPost-neonatal rate Maternal mortality rate Prevalence rate Incidence rate .

INDICATORS. . list of information determined the health of a particular community particularly the population. HEALTH A INDICATORS.

TYPES OF HEALTH INDICATORS  CBR ± Crude Birth Rate  CDR ± Crude Death Rate  IMR ± Infant Mortality/Morbidity Rate  MMR ± Maternal Mortality/Morbidity Rate  NDR .Neonate Death Rate  .

 Serves as indexes of the health condition obtaining in a community or population group.IMPORTANCE/IMPLICATION OF HEALTH STATISTICS is a tool in planning.  It . implementation and evaluating health programs.

.  Serves as basis for determining the success or failure of such services or actions. Provide variables due as to the nature of health services or action needed.

# of total registered live birth x 1.000 Estimated mid year population CBR = .Crude Birth Rate (CBR )  Refers to the number of live birth/1000 population (fertility rate).

This also measures the force of mortality in a 1 year calendar.000 Estimated mid year population .Crude Death Rate (CDR)  Refers to the deaths/1000 population. CDR = # of total deaths x 1.

000 # of registered live births IMR = .Infant Mortality Rate (IMR) Rate  Pertains to the number of death under 1 yr/ 1000 live births # of deaths under1 yr. X 1.

MMR = # of deaths related to pregnancy x 1.Maternal Mortality Rate (MMR)  Refers to the number of deaths related to pregnancy/ 1000 population.000 # of registered live births .

NDR = # of deaths under 28 days x 1.Neonatal Death Rate (NDR)  Refers to the total number of deaths among individual below 28 days old.000 # of registered live births .

which occurs. Nagcarlan.Barangay Wakat. in the same year. In the same year 250 live births are registered at the Municipal Hall. There are 7 mothers who died resulting from pregnancy. Laguna has an estimated mid year population of 550 for the year 2007. IMR. There are 75 deaths from any cause of disease. 15 babies dies during prenatal and post natal period. CDR. MMR . labor and delivery at the same year. Compute for the following: CBR.

 Given: population = 550 # of registered live births = 250 # of registered deaths = 75 # of deaths resulting from pregnancy = 7 # of babies deaths = 15 .

1.000 = (250/550) x 1.000 population Interpretation: There are 454 live births per 1.000 = 454 / 1. CBR = # of total registered live birth Estimated mid year population x 1.000 population .

2. CDR = = = # of total deaths x 1.000 population Interpretation: There are 136 deaths per 1.000 population .000 Estimated mid year population (75/550) x 1000 136 / 1.

000 = (15/250) x 1.000 population . # of registered live births X 1.3.06/ 1. IMR= # of deaths under1 yr.06 infant mortality rate per 1.000 population Interpretation: There are 0.000 = 0.

000 population Interpretation: There are 0. MMR= # of deaths related to pregnancy x 1.4.000 # of registered live births = (7/250) x 1.028 maternal mortality rate per 1.000 population .000 = 0.028 / 1.

of new cases of a particular disease IR = registered during a specific period of time x 100.000 estimated population as of July of same year . Deals only with new cases. No.Incidence Rate  This measures the frequency of occurrence of the phenomenon during a given period of time.

Prevalence Rate  This measures the proportion of the population which exhibits a particular disease at a particular time. Deals with the total number of old and new cases. . This can only be determined following a survey of the population concerned.

No. of new and old cases of a certain PR = disease registered at a given time total number of person examined at same given time x 100 .

Epidemiology The study of the distribution of disease or physiological condition among human populations and the factors affecting such distribution.  The study of the occurrence and distribution of health conditions such as disease. death.  . deformities or disabilities on human populations.

IMPORTANCE AND USES OF EPIDEMIOLOGY IN PUBLIC HEALTH Serve as backbone of the prevention of diseases .

accidents. defects and the chances of avoiding them  .Uses of Epidemiology: according to Morris To study the history of the health population and the occurrences of disease  To diagnose the health of the community and the condition of people  To study the working of health services with a view of improving them  To estimate the risks of disease.

Factors affecting distribution  Person  Intrinsic characteristics Extrinsic factors Temporal patterns  Place   Time  .

PANDEMIC ± when disease occurs worldwide. Example: malaria EPIDEMIC ± when disease occurs in short duration of time or season. chickenpox.Patterns of Disease Occurrence     ENDEMIC ± places where diseases are regularly experience. dengue. Example: SARS. AIDS. occurrences of disease are constant. cholera SPORADIC . Example: rabies. tetanus . Example: measles.when disease occurs on and off.

Steps in EPIDEMIOLOGICAL INVESTIGATION Establish fact of presence of epidemic  Establish time and space relationship of the disease  Relate to characteristics of the group in the community  Correlate all data obtained  .

Establish fact of presence of epidemic Verify diagnosis  Reporting  Is there an unusual prevalence of the disease  .

Establish time and space relationship of the disease Are the cases limited to or concentrated in a particular area  Relation of cases by days of onset to onset of the first known cases (usually done in weeks)  .

groups. past immunization. color. sex. school attendance. occupation.Relate to characteristics of the group in the community Relation of cases to age.  Relation of sanitary facilities  Relation to milk and food supply  Relation of cases to other cases and known carriers if any  .

Correlate all data obtained Summarize the data  Draw final conclusion  Establish source of epidemic and the manner of the spread  Make suggestions as to the control and preventions of future outbreaks  .

Outline on the operational procedure during a disease outbreak          Organization team Epidemiological investigation Collection of laboratory specimens Treatment of patients and contacts Immunization campaign Environmental sanitation Health education Involvement of other agencies Reporting .

Health Care Delivery System  the network of health facilities and personnel. which carry out the task of rendering health care to the people. .

diagnostic. specialized. referrals Surgery. therapeutic and rehabilitative care Rehabilitation PT/OT . medical services by specialist Information dissemination Secondary Diagnosis and Treatment Screening Tertiary Advances.Types Services Types of health services Health promotion and illness prevention Examples Primary Health promotion. attention to psychological and social care. preventive care Continuing care for common health problems.

National  Local  Private  NGO  .Health Sector  groups of services or institutions in the community. which is concern with the protection of the population.

advocate and model in promoting HEALTH FOR ALL in the Philippines  . staunch.DEPARTMENT OF HEALTH VISION  The DOH is the leader.

MISSION  Guarantee equitable. sustainable. and quality health care for all Filipinos. and lead the quest for excellence in health. especially the poor.  .

BASIC PRINCIPLES TO ACHIEVE IMPROVEMENTS IN HEALTH Fostering a strong and healthy nation  Enhancing the performance of the health sector  Ensuring universal access to quality essential health care  Improving macro-economic and social macroconditions for better health  .

and the Medium Term Philippine Development Plan:  . in consonance with the health system goals identified by the WHO. the Millennium Development Goals.FOURmula ONE FOR HEALTH OVEROVER-ALL GOALS:  The implementation of FOURmula One for Health is directed towards achieving the following end goals.

Better health outcomes  More responsive health system  More equitable healthcare financing  .

effectiveness and equality of the Philippine Health System in a manner that is felt and appreciated by Filipinos. . precision and effective coordination directed at improving the quality. efficiency. especially the poor.General Objective:  FOURmula One for Health is aimed at achieving critical reforms with speed.

Components Health Financing  Health Regulation  Health Service Delivery  Good Governance in Health  .

better.Health Financing Objective  To secure more. and sustained investments in health to provide equity and improved health outcomes. especially for the poor.  .

Strategies  Mobilizing resources from extra budgetary sources  Adopting a performance based financing system  Coordinating local and national health spending  Focusing direct subsidies to priority program  Expanding the national health insurance program  .

devices.Health Regulation Objective  Assuring access to quality and affordable health products. facilities and services. especially those commonly used by the poor.  .

Strategies  Harmonizing licensing. accreditation and certification  Issuance of quality seals  Assuring the availability of low-priced lowquality essential medicines commonly used by the poor  .

Health Service Delivery Objective  Improving the accessibility and availability of basic and essential health care for all. This shall cover all public and private facilities and services.  . particularly the poor.

Strategies  Designating providers of specific and specialized services in localities  Ensuring availability of providers of basic and essential health services in localities  Intensifying public health programs in targeted localities  .

Good Governance in Health Objective  Improve the health system both national and local levels  Improve coordination across local health system  Enhance effective private-public privatepartnership  Improve national capabilities to manage health sector  .

Strategies  Estblishisng inter LGU coordination mechanisms like interlocal health zones and other model of appropriate local health systems in the context of devolution.  Developing performance assessment systems that cover local. regional and central health offices  .

Institutionalizing a professional career track mechanisms for human resources for health  Improving management support systems to enhance the delivery of health goods and services.  .

 Local Government Unit ± with the process of devolution (decentralization). . the responsibility for health promotion and protection has become a shared effort between the LGU¶s and the DOH.

commercial organizations. Their involvement includes:     Inputs provision which covers supplies and equipments/treatment and facilities Service delivery activities includes case findings/ treatment and follow-ups.This consists of both commercial and business organizations and nonnon. Support research. environmental followsanitation and to manufacture goods. project monitoring and evaluation and development of IEC materials. counseling. personnel training.  Private Sector . Financing through financial assistance .

 .NonNon-Government Organizations ± plays an important role in national and local development. relief and disaster management and networking. research and documentation. human rights advocates. health resources development personnel. organizers.  They assumed the role of policy and legislative advocates.

. Families and Individuals ± the person who participates and benefited the health care delivery systems. Communities.

This includes hospitals. clinics and laboratories. The government. health centers. private sectors and NGO¶s operates these health facilities today. . Health Facilities ± infrastructures that offers health services. health stations.

The National Health Care Plan A long term plan for health  The blueprint defining the country¶s health  .

low maternal mortality and less disability through measures that will guarantee access of everyone to essential care. . low infant mortality.Goal  To enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economicallyeconomically-productive life. with no longer life expectancy.

Broad objectives: Promote equality in health status among all segments of society  Address specific health problems of the population  .

sanitary food shops and public toilets. passengers terminals. conforms with set of guidelines and standards. safe. conveniently and economically accessible. safe drinking water. prove comfort and security. pleasant place. with public waiting areas.  Hotels/Motels  . Ports  Physical environment: clean. Physical Environment: clean. spacious and secure.

 Street Well maintained roads and public waiting areas  Well mark traffic signs and pedestrian crossing line and visible street names  Clean and obstruction-free sidewalks obstruction With minimal traffic problems  With adequate strict law enforcement  .

in good running condition Manned by a reliable and dependable licensed operators With posters on health promotion and illness prevention Provides rest. comfortable. safe. smoke free. recreation and wholesome entertainment Has sanitary toilets and adequate communication facilities  Movie House   . Vehicles    Clean. well ventilated.

o.Strategies and Methodologies in CHN  Priority for the vulnerable groups Infants (0 ± 1 year old)  Children (1 ± 4 y.o.)  Women of reproductive age (15 ± 44 y.)  Adolescent  Elderly   Key Approach  PRIMARY HEALTH CARE .

Levels of Health Care  Health Promotion       Disease Prevention    Individual wellness Family wellness Community wellness Environmental wellness Social wellness Primary Secondary Tertiary      Focus on screening Case finding Contact tracing MultiMulti-phasing screening surveillance .

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