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


± 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 

went on tour to raise fund for a program on social work.  Frederika Munster Fliedner ± organized Women¶s Society for visiting and nursing the sick poor in their homes  .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 .

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

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

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 .

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.Public Health Nursing in the Philippines PrePre-Spanish Era ± no records  Spanish Regime (1591-1898) (1591 Bro.

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

2156) created Sanitary Division. 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. In the same year public health nursing in the Philippines started.  .1905 ± Act No.

nurseRosario Pastor.   1915 ± Bureau of Health was renamed Philippine Health Service. 1916 to 1918 ± Ms. headed by nurse-physician Dr. 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 . 2462 ± created the office of General Inspection.

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

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. In later year 4 more school were establish  .

1928 ± Fist convention of nurses were held  1933 ± Reorganization Act No. 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  . 4007.

  Japanese Regime (1942-1945) ± Public health (1942nursing were interrupted 1946 ± after world war. Mrs. Genara de Guzman. . the Bureau of Health increased the number of public health nurse. 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.

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. the health education and manpower development service was created. 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. and Bureau of Food and Drug 1986 ± The Ministry of Health became Department of Health again 1991 ± RA 7160 (Local Government Code). .

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  .

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

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

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

. 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.

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

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

 .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.

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

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  .

development and implementation of innovative public health solutions  . 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.

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

NURSING UNDER W.H.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 .

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

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

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  .

) THC (sophisticated medical centers)   CHN practice requires knowledge from biological. 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.

Basic Principles of CHN Recognized needs of communities. 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  . families.

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  .

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. .Role of Public Health Nurse  The roles are varied and dynamic.

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

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

 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 .

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

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

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

 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. consolidates. analyzes and interprets all records and reports  Maintains adequate.

 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.Responsibility of CHN Be a part in developing and overall health plan.

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


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

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


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

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.hostagent. ..hostenvironment model of health and illness for community health (Leavell and Clark ± 1965).Agent ± Host ± Environment Model  The agent.

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

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

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

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.


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

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

 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. .

. 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". It was the first international declaration underlining the importance of primary health care.

often care. is  "essential health care based on practical. abbreviated as PHC. 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" .Primary health care.

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 .

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. 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´.  .




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.

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

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

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

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

physical conditions) . 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. economic.2.

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

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

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

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

chest subclinics. malaria eradication units operated by the DOH Private clinics operated by Philippine medical Association. Primary Level of Health Care Facilities     This are the rural health units. 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. .HEALTH CARE FACILITIES  1. their sub-centers.

. 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.

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

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. curative preventive health care measures  . health auxiliary volunteers. TBA  1st contact of the community (initial link)  Work in liaison with local health service worker  Provide elementary.

referral services and supplies through linkages with other sectors  . training.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.

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.  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.

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.

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

Health Promotion Model (Nola Pender. it is more likely to used again.1996) Individual characteristics and experiences can be useful in predicting if an individual will incorporate and use health related behaviors.´  .  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. beliefs and relationships ± major motivators for engaging in health behaviors. accompanied by developing associated strategies to perform the value behavior.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.SelfSelf-efficacy It is a belief that one has the capabilities to execute the courses of actions required to manage prospective situations.  Example:   A person with high self-efficacy may engage selfin a more health related activity when an illness occurs.

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

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

 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.  .

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. . but will engage in tasks where their selfself-efficacy is high.

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

 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.  .

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

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

and how long it will be sustained in the face of obstacles and failures.  .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.

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

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.

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

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

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

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

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 .

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

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

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

. 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. Health education about standards of nutrition and growth and development. protection against occupational hazard. exercise requirements. recreation and work conditions . stress management.

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

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

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  .TERTIARY LEVEL  Begins after illness.

 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  .

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.o.

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


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. sociocontext. (Maglaya.

belonging. 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. 1996) 1996) . (Spradley & Allender.

Dimensions of a Community LOCATION  POPULATION  SOCIAL SYSTEM  .

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

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

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

Classifications of a community URBAN  RURAL  SUB .URBAN  .

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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


Preventive Curative. 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. Rehabilitative FACTOR AFFECTING HEALTH . Housing ENVIRONMENT Air Food.POLITICAL Safety Oppression People SOCIO ECONOMIC Employment Education.

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

the middle and upper income group have also very pressing health problems such as drug abuse and lifelifestyle diseases. .SOCIOSOCIO-ECONOMIC  Families from the lower income groups are the ones mostly served in public health services and by the community health workers. 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.

. Early knowledge of transmitted. the genetic risk makes it possible to anticipate and counteract genetic outcomes thus enabling the medical team to prepare for necessary therapeutic intervention. intervention.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.

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

exercise. intake of alcoholic drinks. by their culture and ethic heritage. heritage. to a large extent. These may has.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. . health care and child rearing practices are shaped. substance abuse and lack of exercise. The people¶s lifestyle.

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. accessible.HEALTH CARE DELIVERY SYSTEM  HEALTH CARE DELIVERY SYSTEM. Philippines. In the SYSTEM. sustainable and affordable. health. . primary health care is a partnership approach to the effective provision of essential health services that are community based. affordable. acceptable.


HEALTH.´  .COMMUNITY.´  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. physical.

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. Therefore. 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. .

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


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

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

 . 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.

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


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

. A collective. participatory. liberated. transformative. 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.

 A process by which community identifies its need and objective. . 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 continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition. 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. collectively and efficiently on their immediate and long term problems. . working with the people.

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

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

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

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

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

. 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. .

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


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

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

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

 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. .

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

 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. leaders. rhythms and lifestyle of the community.  . economy.

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

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

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

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

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

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


.  To formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies.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.

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  .

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

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 . economic.c.

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. 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 .Priority Setting  Criteria:      nature of the problem presented ±the problems are classified by the nurse as health status.

Criteria Nature of the problem Health status 3 Health resources 2 Health related 1 Magnitude of the problem 75% .74% affected 25% .100% affected 50% .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 .

Individual. Family. 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 .


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

 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  .

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

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

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

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

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

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

 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).

Crude Death Rate (CDR)  Refers to the deaths/1000 population. This also measures the force of mortality in a 1 year calendar. CDR = # of total deaths x 1.000 Estimated mid year population .

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

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.

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

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

000 population .000 = 454 / 1.000 = (250/550) x 1. CBR = # of total registered live birth Estimated mid year population x 1.000 population Interpretation: There are 454 live births per 1.1.

000 population . CDR = = = # of total deaths x 1.2.000 population Interpretation: There are 136 deaths per 1.000 Estimated mid year population (75/550) x 1000 136 / 1.

000 = (15/250) x 1.000 population Interpretation: There are 0. # of registered live births X 1.06/ 1.000 population .000 = 0.06 infant mortality rate per 1.3. IMR= # of deaths under1 yr.

MMR= # of deaths related to pregnancy x 1.000 population .028 / 1.000 population Interpretation: There are 0.000 # of registered live births = (7/250) x 1.4.000 = 0.028 maternal mortality rate per 1.

000 estimated population as of July of same year . of new cases of a particular disease IR = registered during a specific period of time x 100. No.Incidence Rate  This measures the frequency of occurrence of the phenomenon during a given period of time. Deals only with new cases.

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 .

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

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

accidents.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. defects and the chances of avoiding them  .

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

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

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

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.

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

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

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

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

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  .

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

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. especially the poor. . precision and effective coordination directed at improving the quality.General Objective:  FOURmula One for Health is aimed at achieving critical reforms with speed. efficiency.

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

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

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  .

Health Regulation Objective  Assuring access to quality and affordable health products. facilities and services.  . devices. 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  .

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

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. regional and central health offices  .  Developing performance assessment systems that cover local.

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

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

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

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

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

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

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

low infant mortality. . low maternal mortality and less disability through measures that will guarantee access of everyone to essential care.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  .

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

 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  .

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

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