COMMUNITY HEALTH NURSING

3 UNITS LEC-54 HOURS 2 UNITS LAB-102 HOURS PREREQUISITE: NCM 100, TFN, Health Assessment PLACEMENT: 2nd Year , First Semester

COMMUNITY HEALTH NURSING
y COURSE DESCRIPTION: This course covers the concepts

and principles in the provision of basic care in terms of health promotion, health maintenance and disease prevention at the individual , family, community level and special population groups. It includes the study of the Philippine health care delivery system and the global context of public health. It describes what community/public health nursing is in the context of the Philippine health care delivery system and in community development.

TERMINAL COMPETENCIES
At the end of the course, the student will be able to: 1. Apply concepts and principles of Primary Health Care in the context of Community Health Nursing. 2. Assess the health condition of the individual/family/population group/community considering the environmental, political, and economic situation. 3.Identify health needs of the individual/family/population group/community using the standard tools and methodologies. 4. Ensure good documentation and accuracy of recording and reporting system. 5.Observe bioethical principles and the core values(love God, country and people, and caring)

Health as a Multi-factorial Phenomenon Political Factor-this factor refers to one·s leadership. Related concepts include . and how other people concerned are followed to actively participate in the decision-making process. manages. how he rules.

.the determination to pursue something that is in the interest of the majority.the ability of the person to do something.Health as a Multi-factorial Phenomenon y Political will. it involves creating the circumstances where people can use their faculties and abilities at the maximum level in the pursuit of common goals. y Empowerment.

A study of this factor leads one to look into economic factor influence how and at what point the client enters the health care system. . distribution and consumption of goods and services and how these affect health and development.this refers to the production.Health as a Multi-factorial Phenomenon Economic Factor.

. and the client-care provider relationship. the dynamics of health care.Health as a Multi-factorial Phenomenon Socio-cultural Factor-Social and cultural variables influence a client·s health practices.

The environment with which the client lives and work either promote and maintain health or increase the likelihood of illness or even death. .Health as a Multi-factorial Phenomenon Environmental Factor-this refers to the sum total of all the conditions and elements that make up the surroundings and influence the health and health practices of client.

Health as a Multi-factorial Phenomenon Health Care Delivery System .

It precedes disease or dysfunction and is applied to generally healthy individuals or groups y The nurse intervenes with person who have no symptoms at the time of the intervention but who are at risk for developing behaviors that could decrease their health .Levels of Prevention Primary Prevention (Promotive and Preventive) y Generalized health promotion and specific protection against disease.

recreation and work conditions . standards of nutrition and of growth and development for each stage of life.Primary Prevention (Promotive and Preventive) Examples: y Health education about injury and poisoning prevention. stress management. exercise requirements. protection against occupational hazards y Immunization y Risk assessments for specific disease y Family planning services y Environmental sanitation and provision of adequate housing.

Secondary Prevention(Diagnostic and Treatment) y Emphasizes early detection od disease. . Includes preventions of complications and disabilities y The nurse identifies risk factors in a person·s lifestyle that affect physical or mental health. and health maintenance for individuals experiencing health problems. explores the significance of these factors with the person and assist the individual to minimize these risks through education. prompt intervention. counseling and treatment.

Secondary Prevention(Diagnostic and Treatment) Examples: y Screening surveys and procedures of any type y Encouraging medical and dental check-ups y Teaching self-examination for breast and testicular cancer y Assessing growth and development for children y Nursing assessment and care provided to prevent complications .

when a defect or disability is fixed. emphasize use of coping mechanisms .Tertiary Prevention(Rehabilitative) y Begins after an illness. stabilized or determined to be irreversible. y Its focus is to help rehabilitate individuals and restore them to an optimum level of functioning within the constraints of the disability y Nurse·s role is to facilitate any adaptive response to illness/stressors.

Tertiary Prevention(Rehabilitative) Examples: y Referring a client who has had a colostomy to a support group y Teaching a client who has diabetes to identify and prevent complications. y Referring a client with a spinal cord injury to a rehabilitation center to receive training that will maximize use of remaining abilities y Facilitates the grieving process in a severely depressed individual y Teaches range of motion exercises to a person who has experienced a stroke .

Health Belief Model 1.Theories related to Health Promotion/Health Education Pender's Health Promotion Theory 2. . Bandura's Self-efficacy Theory 3.

if people had to rely solely on the effects of their own actions to inform them what to do. .Bandura's Self-efficacy Theory y theory of Bandura emphasizes the importance of observing and modeling the behaviors. not to mention hazardous. and emotional reactions of others. attitudes. y "Learning would be exceedingly laborious.

Bandura's Self-efficacy Theory y ´most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed." . and on later occasions this coded information serves as a guide for action.

Bandura's Self-efficacy Theory y Social learning theory explains human behavior in terms of continuous reciprocal interaction between cognitive. an environmental influences. . behavioral.

affective valence. motor rehearsal). symbolic rehearsal. perceptual set. (3)Motor Reproduction. (2)Retention.Bandura's Self-efficacy Theory The component processes underlying observational learning are: (1)Attention. vicarious and self reinforcement. arousal level. functional value) and observer characteristics (sensory capacities. and (4)Motivation. including external. including symbolic coding. cognitive organization. . selfobservation of reproduction. accuracy of feedback. including modeled events (distinctiveness. including physical capabilities. complexity. past reinforcement). prevalence.

Bandura's Self-efficacy Theory y Because it encompasses attention. memory and motivation. social learning theory spans both cognitive and behavioral frameworks. y Bandura's theory improves upon the strictly behavioral interpretation of modeling .

.Bandura's Self-efficacy Theory y It is the theoretical foundation for the technique of behavior modeling which is widely used in training programs.

Depending upon the component processes involved (such as attention or motivation). Commercials suggest that drinking a certain beverage or using a particular hair shampoo will make us popular and win the admiration of attractive people. .Bandura's Self-efficacy Theory Example: y The most common (and pervasive) examples of social learning situations are television commercials. we may model the behavior shown in the commercial and buy the product being advertised.

2. 3. Coding modeled behavior into words. Individuals are more likely to adopt a modeled behavior if it results in outcomes they value.Principles: 1. The highest level of observational learning is achieved by first organizing and rehearsing the modeled behavior symbolically and then enacting it overtly. Individuals are more likely to adopt a modeled behavior if the model is similar to the observer and has admired status and the behavior has functional value . labels or images results in better retention than simply observing.

Pender's Health Promotion Theory .

Rosen stock/Becker·s Health-Belief Model .

Health Education Theories .

PAPER AND PENCIL TEST y 20 items test .

RLE Activities y Conduct interview of family regarding their health promotion and disease prevention activities and report in front of the class via collage/creative output/drawing .

Concept of Public Health and Community Health Nursing A. Economics in Public Health 6. Core Functions of Public Health 5. Concept of Public Health 1. Principles of Public Health 4.II. Definition and Philosophy 2. Historical background 3. Roles and Function of Public Health Nurse .

Paper and pencil test y 20 items test .

RLE activities y Interview of a Public health nurse in different work settings .

Nursing Theories related to CHN 5.B. Definition and Philosophy 2. Concept of Community Health Nursing 1. Goals and objectives 3. Concepts and Principles of CHN . Historical development of Community Health Nursing in the Philippines 4.

Paper and Pencil test y 20 items test .

Occupational Health Nursing 3. Community Mental Health Nursing . Specialized Field in Community and Public Health Nursing 1. School Health Nursing 2.C.

Paper and Pencil Test y 20 item test .

Millennium Development Goals 4. National objectives for health 3. Levels of Health Care Facilities . The Department of Health 1.III. Philippine Health Care Delivery System A. Vision/Mission/Objectives/Strategies 2.

and each of those parts can be viewed as a subsystem with its own set of interrelated and independent parts.III.a set of interrelated and interdependent parts that form a complex whole. Philippine Health Care Delivery System Definition of Terms: System. .

and other related sectors. . educational institutions. communities.is the interrelated ways in which a country organizes available resources for the maintenance and improvement of health of its citizens and communities. It consists of interrelated components in homes. the health sector. workplaces.Definition of Terms: Health System.

It is composed of health care institutions. restore or maintain healthµ.µ . financing mechanisms. organizational structures that link them together and collectively culminate in the delivery of health services to patients. ´a health system is composed of all activities whose primary purpose is to promote.Health System According to the World Health Organization (WHO). information systems. supporting human resources.

financing and stewardship Stewardship-management's responsibility to properly utilize and develop its resources. its property and its financial assets . including its people.Health System y The four essential functions of a health system have been defined as service provision. resource generation.

Health Care Delivery System.groups of services or institutions in the community or country which are concerned with the health protection of the population.Definition of Terms: Health Sector. which carry out the task of rendering health care to the people. .the network of health facilities and personnel.

products.Definition of Terms: Health Care Delivery System-is the totality of all policies. human resources and services that address the health needs. equipment. . infrastructures. facilities. problems and concerns of all people.

2.Characteristics of a Health Care System based on PHC 1. . It should include components from the health sector and from the sectors whose interrelated actions contribute to health. The system should encompass the entire population on the basis of equality and responsibility.

Characteristics of a Health Care System based on PHC 3. 4. The other level of the health system should support the first contact level to permit it to provide the aforementioned essential elements on a continuing basis. . The essential elements of primary health care should be delivered at the first point of contact between individuals and the health systems.

6. .Characteristics of a Health Care System based on PHC 5. The central level should coordinate all parts of the system and provide planning and management expertise. highly specialized care. teaching for specialized staff. At intermediate levels more complex problems should be dealt with more skilled and specialized care as well as logistic support.

Being aware of these levels will also facilitate the delivery of health care services to the people thus promoting equal access to basic health services. .Levels of Health Care Facilities This levels of health care facilities will certainly guide the health care provider in referring case or when requesting for further medical management.

Primary level of Health Care Facilities This is composed of barangay. Example: Barangay Health Station(BHS) Rural Health Station It is also composed of private clinics. clinics operated by large industrial firms for their employees. . community hospitals and health centers.Levels of Health Care Facilities 1. municipal and Medicare health care institutions which have facilities and capabilities for first contact emergency care.

.Primary level of Health Care Facilities Health services offered at this level are to individuals in fair health and to patients with diseases in early symptomatic stages.

Secondary level of Health Care Facilities This consists of district health care institutions with capabilities and facilities for medical care of cases requiring hospitalization. It has expertise of trained specialists. Example: Municipal Hospital(JP?) with 50-100 bed capacity .Levels of Health Care Facilities 2.

Secondary level of Health Care Facilities They are smaller. non-departmentalized hospitals. . Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require moderately specialized knowledge and technical resources for adequate treatment.

provincial. Tertiary level of Health Care Facilities Specialized centers. regional health care institutions. They have capabilities for providing medical care to cases requiring sophisticated diagnostic and therapeutic equipment and expertise of trained specialist.Levels of Health Care Facilities 3. Example: Regional Medical Center with complete facilities and above 100 bed capacities. .

. facilities and personnel to treat effectively.Tertiary level of Health Care Facilities Are the highly technological and sophisticated services offered by medical centers and large hospitals. Services rendered at this level are for clients afflicted with disease which seriously threaten their health and require highly technical and specialized knowledge. These are the specialist national hospitals.

they need to consult other health care providers/facilities to meet the demands of the consumers.Referral System To be able to deliver basic health services to the consumers. and they should not manage health situations by themselves alone. the health care provider should follow a particular flow of communication. Utilizing a referral system for certain will facilitate the achievement of this particular purpose. .

.Referral System As one of the active participants I the health care system you have to be aware that there are certain situations that we can not manage at our own level and we have to consult or refer this to other colleagues in the health profession if we want to satisfy our clients as ourselves.

2 Way Referral System Insert a diagram of 2 way referral system .

Implementing rules and guidelines in the health care delivery system should be followed strictly to avoid the existence of inequality in health care services.2 Way Referral System It appears therefore that the health care system itself does not operate by itself alone. . accessible to al. Health care services should be delivered where the people are and should be available. And no health care facilities can claim or dominate the solution of health conditions.

and Individuals II-Health Facilities a. Private Subsector c. Non-government Organizations d. Government Subsector b. Communities. Families. Hospitals b.Philippine Health Care System I-Structure of the Health Sector a. Private Clinics and Laboratories III-Health Services Primary Health Care IV-Health Human Resource Development IV-Health Care Financing . Health centers and Barangay Health Stations c.

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non-government and people· s organizations. infrastructurehasmovedfromhighlycentralizedsystemtowardsgreaterparticipationoflocal organizationsinhealthadministrationandmanagement. Recently the .Thehealthsectoris composed mainly of the government.Philippine Health Care System I-structureofthehealthsector The Philippine health care delivery system(PHCDS) has gone through development transformations over the decades as a changes in the demographic. socio-economic and political. environmental.Also. cultural and technological context took place.altogether contributing to health in different roles with the ultimate goal of improvingthehealthstatusandqualityoflifeofthe people.itistakenacollaborativestance intoamaturingpartnershipbetweenthepublicandprivatestakeholders. . private institutions.

or as health service arms of other departments like military hospitals and mobile team of the Department of National Defense(DND). the Medicare Commission. . the occupational health and safety center of the Department of Labor and Employment(DOLE) and the National Nutrition Council. Philhealth. Government Subsector In the Philippines it is composed o f the Department of Health. the medical and dental services of the DECS. the medical services of the penal institutions.Philippine Health Care System I-Structure of the Health Sector A. and those government entities serving as district health agencies by themselves such as the Philippine GeneralHospital.

especially the poor and to lead the quest for excellence in health. sustainable and quality health for all Filipinos.Philippine Health Care System I-Structure of the Health Sector The Department of Health (DOH) Vision: HEALTH FOR ALL FILIPINOS Mission: Guarantee equitable. .

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16 Centers for Health Development in various regions. 70 hospitals and 4 attached agencies .Philippine Health Care System I-Structure of the Health Sector DOH y Composed of 17 offices.

Formulation and development of national health policies.Philippine Health Care System I-Structure of the Health Sector The DOH mandate: The DOH shall be responsible for the following: 1. guidelines standards and manual of operations for health services and programs .

goals. priorities. Promulgation of national health standards. and indicators 4. .The DOH Mandate The DOH shall be responsible for the following: 2. licenses and accreditations 3. Development of special health programs and projects and advocacy for legislation on health policies and programs. Issuance of rules and regulations.

Sec.3)µ .O No.119.Protection.The DOH mandate: Primary Function of DOH: ´Promotion.Preservation or restoration of the health of the people through the provision an delivery of health services and through the regulation and encouragement of providers of health goods and services(E.

The National Health Goal 1. Improve the general health status of the population: y Reduce infant mortality rate y Reduce child mortality rate y Reduce total fertility rate y Increase life expectancy and quality of life years .

The National Health Goal 2 Reduce morbidity. disability and complications from the following diseases and disorders: y Diarrheas and other food and water borne diseases like typhoid. mortality. and other reproductive tract infections y Hepatitis B . cholera and hepatitis A y Pneumonia and acute respiratory infections y Tuberculosis y Dengue y Intestinal parasitism y Sexually transmitted diseases. HIV/AIDS.

hypertension and dyslipidemia y Stroke y Cancer y Diabetes mellitus y Asthma and chronic obstructive pulmonary diseases y Nephritis and other kidney diseases y Mental disorders y Protein-energy malnutrition y Iron deficiency anemia y Obesity y Accidents.y Dental caries and other periodontal diseases y Rheumatic heart disease and rheumatic fever y Coronary heart disease. and injuries . trauma.

y Schistosomiasis. Leprosy y Vaccine preventable diseases: measles.The National Health Goal 3. diphtheria and pertussis y Vitamin A deficiency and iron deficiency diseases . Rabies. malaria. Eliminate the following diseases as public health problems. tetanus. filariasis.

The National Health Goal 4. Eradicate poliomyelitis 5. Promote Healthy life style y Promote healthy diet and nutrition y Promote physical activity and fitness y Promote personal hygiene y Promote mental health &less stressful life y Prevent smoking & substance abuse y Prevent violent & risk-taking behavior .

The National Health Goal 6. Promote the Health and Nutrition of families & special population y y y y y y y y y y Neonatal & infant health Children·s health Adolescent and youth health Adult·s health Women·s health Health of older people Health of indigenous people Health of overseas Filipino workers Health of the disabled persons Health of the rural and urban poor .

establishments and communities. .The National Health Goal 7. Promote environmental health and sustainable development through the promotion and maintenance of healthy homes. workplaces. towns and cities. schools.

2. 4.Basic Principles to Achieve improvement in Health Universal access to basic health services must be ensured. 3. The performance of health sector must be enhanced. . The epidemiological shift from infection to degenerative must be managed. The health and nutrition of vulnerable groups must be prioritized. 1.

Strategies to achieve health goals
y Increasing investments for Primary Health Care y Development of National Standards and objectives for health y Assurance of the Quality of Health Care y Support to the Local Health System Development y Support for frontline Health Workers

Functions of DOH
Before devolution: Lead agency in health(mandated by constitution to protect and promote and instill health consciousness among them, formulation and implementation of policies, programs and projects, and delivery of care service.

Functions of DOH
After devolution: Lead agency in health thru implementation to a regulator . DOH became a ´ service of serviceµ providers or ´ servicer of the servicesµ ,provides the direction and national plans for health program and services. y Devolution is the statutory granting of powers from the central government of a state to government at a sub national level, such as a regional, local, or state level.

Medical Centers Sanitaria Provincial Health Offices Provincial Hospitals District Health Offices City Health Offices District Medicare & Municipal Hospitals Municipal Health Offices BHSs .DOH Structure (Pre-devolution) Office of the Secretary of Health Executive Committee for National Field Operations 15 Regional Field Offices Regional Hosp.

Medical Centers Sanitaria 15 Regional Field Offices Provincial Health Offices District Health Offices Provincial Hospitals A City Health Offices B District Medicare & Municipal Hospitals C Municipal Health Offices BHSs .Health Structure (1993. Post-devolution) Office of the Secretary of Health Executive Committee for National Field Operations A B C Devolved to Prov¶l Gov¶t Devolved to City Gov¶t Devolved to Municipal Gov¶t Regional Hosp.

851) Re-organization of the DOH in 1987 (E.A.SIGNIFICANT MILESTONE IN PAST 25 YEARS Adoption of the Primary Health Care in 1979 Integration of Public Health and Hospital Services in 1983(E. 7160) Currently the DOH is streamlining its organization and functions as mandated by (E.O.O. 119) Devolution of Health Services in 1992 to LGU·s as mandated under the Local Government Code of 1991(R.O 102) .

SIGNIFICANT MILESTONE 2006 y The Presidential Anti-Graft Commission recognized and awarded the DOH as the number one government agency in fighting corruption. DOH also topped in the Pulse Asia 3rd Quarter Survey as the number one government agency in terms of overall performance. .

SIGNIFICANT MILESTONE 2005 y FOURmula ONE for Health (F1) was launched as the health sectors blue print for the implementation of reforms to bring about better health outcomes. Province-wide Investment Plans for Health were developed in 16 provinces as the basis of F1 implementation in these sites. . more responsive health system and more equitable healthcare financing.

access and quality health care in the country. efficiency. A major breakthrough was achieved in providing fiscal autonomy to 68 DOH retained hospitals with the approval of a special provision of FY 2003 GAA which authorized 100% retention and the use of hospital income for upgrading of health facilities and services. . S. synchronicity and focused targeting of priority public health programs that would provide the biggest impact to attaining equity. 2003) to orchestrate unity.SIGNIFICANT MILESTONE 2003 y The One-Script Systems Improvement Program was established (AO 50.

2001. It is also during this year that the 13 convergence sites or the advance implementation areas have been established. Manuel Dayrit. Administrative Order 37 which contained the guidelines on the operationalization of the HSRA implementation plan was signed by Sec. .SIGNIFICANT MILESTONE y 2001 y In July 13.

The HSRA has become the major framework for policies and investments for the health sector .SIGNIFICANT MILESTONE y 2000 y The year 2000 marked the institutionalization of the Health Sector Reform Agenda (HSRA). . national and local stakeholders in health. and partners in the international community. The HSRA was endorsed for approval and support by the National Government Agencies.

The reforms are: provide fiscal autonomy to government hospitals. major chronic illnesses and injuries that compromise lives of the productive sector. It encourages promotion of healthy lifestyle and health-seeking behaviors to prevent or control certain debilitating illness and life-threatening diseases y .SIGNIFICANT MILESTONE y 1999 y The functions and operations of the DOH was directed to become consistent with the provisions of Administrative Code 1987 and RA 7160 through Executive Order 102. strengthen the capacities of health regulatory agencies and expand coverage of the National Health Insurance Programs. promote the development of local health systems and ensure its effective performance. The Health Sector Reform Agenda of the Philippines. 1999-2004 was launched. National Objectives for Health 1999-2004 was launched. This states the Philippines objectives for the eradication and control of infectious diseases commonly affecting our people. secure funding for priority health programs.

Doctors to the Barrios Program. Disaster Management. National Micronutrient Campaign.SIGNIFICANT MILESTONE 1992 y Full implementation of Republic Act No. Two big offices merged to become the Office of Hospital Facilities. . Traditional Medicine. Special projects were highlighted like the NID. Urban Health and Nutrition Project. 7160 or Local Government Code. Standards and Regulation. The DOH changed its role from one of implementation to one of governance. "Let·s DOH It"! became a national battle cry. Significant change: branching out of the Office of the Public Health Services to form the Office for Special Concerns.

which placed under the Secretary of Health five offices headed by an undersecretary and an assistant secretary. Standard and Regulations. and Management Service. 119. Hospital and Facilities Services. . Public Health Services.SIGNIFICANT MILESTONE 1987 y Another re-organization under Executive Order No. These offices are the Chief of Staff.

.SIGNIFICANT MILESTONE 1986 y The Ministry of Health became Department of Health again.

SIGNIFICANT MILESTONE 1982 y Under Executive Order No. . the Health Education and Manpower Development Service was created. 851. and the Bureau of Food and Drugs assumed the functions of the Food and Drug Administration.

Population Commission. The Ministry was divided into 12 regions covering several provinces and cities under a regional health director. Sept.1.24. pursuant to Presidential Decree No. the Dangerous Drugs Board.SIGNIFICANT MILESTONE 1972 y Through Letter of Implementation No. 1972. Attached offices were the Philippine Medical Care Commission. National Nutrition Council. . the DOH was renamed Ministry of Health. The National Cancer Center and Radiation Health Service were created. National Schistosomiasis Control Council and the Tondo General Hospital. 8.

among others. . National Nutrition Program. and the National Schistosomiasis Control Commission. Bureau of Dental Health Service. the National Comprehensive Maternal and Child Health / Family Planning Program. Malaria Eradication Service.SIGNIFICANT MILESTONE 1958 y The creation of eight regional health offices and two Undersecretaries of Health: the Undersecretary of health and the Medical Services and the Undersecretary of Special Services. 1971 The creation of the Food and Drug Administration. Bureau of Disease Intelligence Center.

in exchange for which the drug Inspection Division was transferred to the former office from the latter.SIGNIFICANT MILESTONE 1950 y Under Executive Order No. and the Public Schools Medical and Dental Services from the Office of the President of the Philippines and the Bureau of Public School respectively to the DOH. . Within the Department of Health. directly under the Office of the Secretary. 1950. the Department of Health gained additional functions brought about by the transfer of the Institute of Nutrition. the conversion of the Section of Tuberculosis into a Division of Tuberculosis. 392. certain changes were also effected thru the transfer of the Division of Health Education and Information from the Bureau of Health to the Department proper. s. together with the Division of Biological Research and the Division of Food Technology from the Institute of Science. and the conversion of the Division of Laboratories into an Office of Public Health Research Laboratory.

series of 1947 with the transfer of the Bureau of Public Welfare to the Office of the President and the Department was renamed Department of Health (DOH). Under this set-up were the following: . 94.SIGNIFICANT MILESTONE 1947 y Reorganization of government offices under Executive Order No.

SIGNIFICANT MILESTONE
y Office of the Secretary , composed of the Division of

Administration, Accounting, Drug Inspection, Nursing Service ( newly- created ), Laboratories (included the Alabang Vaccine & Serum Laboratories which was previously under the Institute of Hygiene, University of the Philippines; the Malaria Control Section, Tuberculosis Control Section, and the Social Hygiene), and the Board of Examiners ( Medical, Dental, Nursing, Pharmaceutical and Optical)

1947 y Bureau of Health ( enforced preventive measures for the promotion, protection , and preservation of health of the people and the maintenance of the sanitary conditions therein ) y Bureau of Quarantine y Bureau of Hospitals (an offspring of the Bureau of Health which was established to attend to the curative phase) All City Health Departments

SIGNIFICANT MILESTONE
01 January 1941 y Creation of the Department of Health and Public Welfare as provided for in Executive Order No. 317, series of 1941. The Department was under the Secretary of Health and Public Welfare and also included the Bureau of Quarantine; the health department of chartered cities; the provincial, city and municipal hospitals; dispensaries and clinics, the public markets and slaughter houses; the health resorts; and all charitable and relief agencies. However, the Philippine General Hospital was detached from the Department and transferred to the Office of the President of the Philippines.

and the five examining boards (medical. 4007. dental.SIGNIFICANT MILESTONE 1932 y Passage of Act No. which created the Office of the Commissioner of Health and Public Welfare. . the Philippine General Hospital. optical and nursing). pharmaceutical. also "the Reorganization Act of 1932".

SIGNIFICANT MILESTONE 1915 y Changing of the name of the Bureau of Health to the Philippine Health Service. . which was later on changed to its former name.

SIGNIFICANT MILESTONE 1912 y Passage of Act.called "Fajardo Act". 2156. No. so. which authorized the consolidation of municipalities into sanitary division and established what is now known as the "Health Fund" .

SIGNIFICANT MILESTONE 1906 y Passage of Act No. 307 wherein the provincial Board of Health gave way to the Office of the District Health Officer . 1487 of the Philippine Commission repealing Act No.

1407.creation of the Board of Health for the Philippine Islands. y Act. completing the health organisation in accordance with the territorial division of the Islands. No. No. Edie as the first Commissioner of Public Health. Guy L. . y Act.SIGNIFICANT MILESTONE 1899 .1905 y Abolition of the Board of Health and appointment of Dr. 308 and 309-establishment of the Provincial and Municipal Boards of Health. 307. 157 of the Philippine Commission . it also acted as the Board of Health for the city of Manila y Acts Nos.(also the "Reorganization Act" ) abolition of the Board of Health and its functions and activities were taken over by the Bureau of Health.

. 15.SIGNIFICANT MILESTONE 29 September 1898 y Establishment of the Board of Health for the City of Manila under General Orders No.

respectively) through the Proclamation of President Emilio Aguinaldo. and Department of Health. . Education & Hygiene (now the Department of Public Works & Highways. Department of Education Culture & Sports.SIGNIFICANT MILESTONE 23 June 1898 y Creation of the Department of Public Works.

Health Research and Development Health surveillance and information system Resource generation for priority health service Technical assistance and logistics support the local health services. 3. 5. 2. Human resources capability-building in health .RESPONSIBILITIES OF DOH UNDER THE DEVOLVED SET-UP 1. 4.

Health Preparedness and Response Emergency 10. Assessment and Evaluation of the Health Situation . Health Promotion and Advocacy 7. Health Care Financing 9. Delivery for specialized health care 8.RESPONSIBILITIES OF DOH UNDER THE DEVOLVED SET-UP 6. Monitoring.

RESPONSIBILITIES OF DOH UNDER THE DEVOLVED SET-UP
11. Quality Assurance for Health Care-Sentrong Sigla Movement 12. Networking for Sectoral Action in health-Direct Service

B. The Private Subsector
Consists of commercial and business organizations, and noncommercial organizations.

B. The Private Subsector
Commercial organizations have a clear profit orientation and include manufacturing companies and advertising agencies, private practitioners, and private institutions like private hospitals, health maintenance organizations, and medical/allied schools .

. and community organizing: and this includes the socio-civic groups. The Private Subsector Non-commercial groups is oriented towards social /development relief and rehabilitation.B. religious organizations and foundations.

Service delivery which includes a whole range of activities from case finding /treatment and follow-up.B. counseling. The Private Subsector Its involvement includes the ff: 1. 2. environmental sanitation. Inputs provisions which covers supplies and equipment/treatment facilities. to manufacture and sale of health related goods. .

B. The Private Subsector Its involvement includes the ff: 3. and development of IEC materials. personnel training. 4. Support activities mostly in the form of research. Financing through financial assistance that usually comes in the form of grants from multilateral and bilateral agencies. . project monitoring and evaluation.

Non-Government Organizations NGO·s play an important role in national and local development with emphasis on policy and program reforms and people empowerment.C. NGO·s have consistently assumed the role of catalysts. advocates. . facilitators and enablers in people development.

y Some of them have pioneered alternative approaches in health. . Non-Government Organizations y Health NGO·s are those that are directly involved in health care and reforming the present health care delivery system.C.

. Families. Increasing self-care that illustrates people·s self-reliance in areas not genuinely requiring professional help. and Individuals y The new emphasis on people on people participation in health development is indicated by four major trends that will permeate into the 21st century: 1. 3. increasing the demand for health service. Improving habits that actualize responsibility for health . and 4.D. 2. preventive medicine and holistic care. More educated communities. Communities. both the quantity and quality. The emphasis on the new paradigm of wellness.

Hospitals b. Health centers and barangay health stations c. Private clinics and Laboratories . a.II-HEALTH FACILITIES These are physical infrastructures that offer health services.

y Government health facilities provide promotive.III-HEALTH SERVICES(PHC) y The type of health services offered includes a wide array of promotive. curative. preventive. and rehabilitative services. . while private sector focus more on direct personal care that are curative and rehabilitative in nature. preventive. and rehabilitative services. curative.

CDD. victims of calamities and disaters. For Infants and Children(Fully immunized Child. For special communities(Indigenous communities. For young and Adolscents(National Program for Youth and Adolescents-1995) 3. For Women-(Maternal and Child Health. information dissemination.PRIMARY HEALTH CARE Essential Health Services offered and cater to specific population group: 1. CARI. For Elderly-(Services geared towards reduction of chronic degenerative diseases 5. Micro Nutrition. Targated Food Assistance Program(TFAP). For Workers 6. victims of armed conflict) . Responsible Parenthood) 4. Safe Motherhood. Supplementation 2.

community generated resources and donation of cash. WHO recommends that 5% of the country·s gross national product(GNP) shall be for the health.USAID.UNICEF. payments). it was placed only on the government third party schemes(Medicare program. y Private sources(out-of-pocket.CIDA.IV-HEALTH CARE FINANCING y Financing is from government. However.GTZ.JICA. material and technical services from Philanthropists or donors. UNFPA) . Phil health. Employee·s compensation). company finance health benefits. external sources(WHO.World bank. HMO.

the Health Organization. the agency inherited the mandate and resources of its predecessor.WHO The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. . and headquartered in Geneva. Established on 7 April 1948. Switzerland. which had been an agency of the League of Nations.

UNICEF provides long-term humanitarian and developmental assistance to children and mothers in developing countries.000. UNICEF relies on contributions from governments and private donors and UNICEF's total income for 2006 was $2. In 1953. Headquartered in New York City. UNICEF became a permanent part of the United Nations System and its name was shortened from the original United Nations International Children's Emergency Fund but it has continued to be known by the popular acronym based on this old name. 1946. UNICEF was awarded the Nobel Peace Prize in 1965 and the Prince of Asturias Award of Concord in 2006 . Governments contribute two thirds of the organization's resources. UNICEF's programs emphasize developing community-level services to promote the health and well-being of children.781.000.UNICEF The United Nations Children's Fund (or UNICEF) was created by the United Nations General Assembly on December 11. to provide emergency food and healthcare to children in countries that had been devastated by World War II. private groups and some 6 million individuals contribute the rest through the National Committees.

adolescence development and participation. and abuse. life skills based education and child rights all over the world. Child protection from violence. UNICEF works to improve the status of their priorities through 14 methods ranging from direct and legal interventions to education and beyond to research and census data collection. HIV/AIDS and children. Basic Education and Gender Equality (including girls' education). .Priorities UNICEF is currently focused on three main priorities: Child Survival and Development. exploitation. and Policy advocacy and partnerships for children·s rights. Related areas of UNICEF action include early childhood development.

It provides assistance in Sub-Saharan Africa. Agriculture. and humanitarian assistance. Conflict."[3] y USAID advances U. recover from a disaster or striving to live in a free and democratic country. Democracy. USAID is organized around three main pillars: Economic Growth.. and Eurasia.USAID y The United States Agency for International Development (USAID) is the United States federal government organization responsible for most non-military foreign aid. Europe. foreign policy objectives by supporting economic growth. Latin America and the Caribbean.. agriculture and trade. democracy.S. An independent federal agency. Asia and the Near East. and Trade. it receives overall foreign policy guidance from the United States Secretary of State and seeks to "extend a helping hand to those people overseas struggling to make a better life. and Humanitarian Assistance. . conflict prevention. health. Global Health.

It is commonly known by the acronym "JICA". .JICA JICA-Japan International Cooperation Agency y is an independent governmental agency that coordinates official development assistance (ODA) for the government of Japan. y It is chartered with assisting economic and social growth in developing countries. and the promotion of international cooperation.

The GTZ mainly operates on behalf of the Federal Ministry for Economic Cooperation and Development (BMZ).GTZ (German Technical Cooperation) or GTZ is a private international enterprise founded in 1975 by Erhard Eppler and owned by the German Federal Government. Further clients are other departments of the government. specializing in technical cooperation for sustainable development with worldwide operation. The cooperation with private enterprises is an emerging field in the domain of sustainable development promotion. international donors like the European Union. partner countries and the private sector. Germany. World Bank or the United Nations. The GTZ is set up with International Services (IS) and the Public Private Partnership (PP . It primarily works for public sector organizations and is headquartered in Eschborn.

economic policy advice. implementing international environmental regimes or environmental policy) Agriculture. Health and Social Security (including working fields such as education. All surpluses generated are channeled back into its own international cooperation projects for sustainable development. land management. market-oriented farming and food systems. development-oriented drug control. Democracy and Poverty Reduction (including services and working fields such as such as development-oriented emergency aid. financial systems development or private sector promotion) Government. peace building and crisis prevention. . sustainable urban development or structural poverty reduction) Education.GTZ provides services in the following areas of sustainable development: The GTZ Economic Development and Employment (including services such as vocational training. natural resource management. Fisheries and Food (including services such as coastal zone management. governance. energy and water management. promotion of children and young people or HIV/AIDS prevention) Environment and Infrastructure (including activities such as waste. transport and mobility. policy advice on agriculture and rural development or securing livelihoods in marginal rural areas) GTZ works on a public-benefit basis.

and operates in partnership with other Canadian organizations in the public and private sectors as well as other international organizations. Its mandate is to "support sustainable development in developing countries in order to reduce poverty and contribute to a more secure."[1] CIDA is overseen by the federal Minister of International Cooperation.[2] . and has its headquarters at 200 Promenade du Portage in Gatineau.CIDA y The Canadian International Development Agency (CIDA) was formed in 1968 by the Canadian government. Quebec. CIDA administers foreign aid programs in developing countries. It reports to the Parliament of Canada through the minister for International Cooperation. equitable. Oda. and prosperous world. currently the Honourable Beverly J.

CIDA is a partner in the Canada Iraq Marshlands Initiative. 2. and water supply. land degradation. . and good governance. Environmental sustainability With a focus upon issues such as climate change. Social development CIDA has supported programs relating directly to the treatment of STDs in third-world countries. 4. democracy. CIDA seeks to help developing nations maintain healthy ecosystems. It also cites basic education and child protection as priorities in the social development of countries that it aids. Governance CIDA strives for human rights. The agency supports gender equality and funds programs that benefit women directly. Economic well-being 3.CIDA Priorities 1.

.WORLD BANK The World Bank is an international financial institution that provides financial and technical assistance to developing countries for development programs (e. bridges. roads. schools.g.) with the stated goal of reducing poverty. etc.

Millennium Development Goals The World Bank's current focus is on the achievement of the Millennium Development Goals (MDGs).C. lending primarily to "middle-income countries" at interest rates which reflect a small mark-up over its own (AAA-rated) borrowings from capital markets. D. .WORLD BANK Activities The World Bank headquarters in Washington.

governments and communities. Asia and the Pacific. and the sub-Saharan Africa. including HIV/AIDS. They work in more the 140 countries. Latin America and the Caribbean. The UNFPA works in partnership with other United Nations agencies.UNFPA Population Fund (UNFPA) began operations in 1969 as the The United Nations United Nations Fund for Population Activities (the name was changed in 1987) under the administration of the United Nations Development Fund. the agency raises awareness and assembles the support and resources needed to attain the Millennium Development Goals. Some of the UNFPA work involves providing supplies and services to protect reproductive health. which expands out into areas such as prevention of sexually transmitted diseases. Working together. the Arab States and Europe. . Around three quarters of the staff work in the field.[2][3][4] The UNFPA supports programs in four areas. They also encourage participation by young people and women to help rebuild their societies who are affected by poor reproductive health.[1] In 1971 it was placed under the authority of the United Nations General Assembly. territories and areas.

UNFPA
Role The UNFPA stated mission is to promote the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programs to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. The agency·s main goals are: Universal access to reproductive health services by 2015 Universal primary education and closing the gender gap in education by 2015 Reducing maternal mortality by 75 per cent by 2015 Reducing infant mortality Increasing life expectancy Reducing HIV infection rates

V-HEALTH HUMAN RESOURCE DEVELOPMENT
HHR is the totality of skills, knowledge and capabilities for national health development. The health system requires different types of health personnel properly and adequately delivers the services necessary to promote and maintain the well-being of the people.

HHR development is a triad of activities:
PLANNING-enables the health system to rationalize the production and management of health personnel 2. PRODUCTION-is dependent on all levels of the educational system from primary up to the university level 3. MANAGEMENT-is dependent on the nature and character of the health system, the institution offering continuing education, current programs of professional associations and pervading professional attitudes.
1.

IV-RELATED LAWS & POLICIES IN PUBLIC HEALTH y Magna Carta for Health Workers y Sanitation Code y Clean Air Act y Generic Act y National Health Insurance Act y National Services Blood Act y Laws on Notifiable Diseases y Senior Citizen Law y Revised Dangerous Drugs Law y Act On Cheaper Medicines .

Vital Statistics refers to the systematic study of vital events such as births.V-HEALTH STATISTICS & EPIDEMIOLOGY VITAL STATISTICS Statistics refers to a systematic approach of obtaining. . marriages. illnesses. divorce. organizing and analyzing numerical facts so that conclusion may be drawn from them. separation and deaths.

V-HEALTH STATISTICS & EPIDEMIOLOGY Statistics of disease (morbidity) and death (mortality) indicate the state of health of a community and the success or failure of health work. In cities. . births and deaths are registered at the City Health Department. Births and Deaths are registered in the Office of the Local Civil Registrar of the municipality or city.

V-HEALTH STATISTICS & EPIDEMIOLOGY Use of Vital Statistic: .Indices of the health and illness status of a community .Serves as bases for planning. monitoring and evaluating community health nursing programs and services . implementing.

Population Census .Health Survey .Studies and researches .Registration of Vital data .V-HEALTH STATISTICS & EPIDEMIOLOGY y Sources of Data: .

Ratio ² is used to describe the relationship between two (2) numerical quantities or measures of events without taking particular considerations to the time or place. although the unit of measures must be the same for both numerator and denominator of the ratio. . it is evident that the person experiencing the event (Numerator) must come from the total population exposed to the risk of same event (Denominator). These quantities need not necessarily represent the same entities.V-HEALTH STATISTICS & EPIDEMIOLOGY y Rates and Rations: Rate ² shows the relationship between a vital event and those persons exposed to the occurrence of said event. within a given area and during a specified unit of time.

Crude Birth Rate ² a measure of one characteristic of the natural growth or increase of a population. .V-HEALTH STATISTICS & EPIDEMIOLOGY Crude or General Rates ² referred to the total living population. Specific Rate ² the relationship is for a specific population class or group. It limits the occurrence of the event to the portion of the population definitely exposed to it. It must be presumed that the total population was exposed to the risk of the occurrence of the event.

of live births registered in a Given calendar year CBR = _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ x 1. Total No.000 Estimated population as of July 1 of same year .V-HEALTH STATISTICS & EPIDEMIOLOGY Crude Birth Rate ² a measure of one characteristic of the natural growth or increase of a population.

Total No. of death under 1 year of age registered in a given calendar year IMR = _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ x 1.Infant Mortality Rate ² measures the risk of dying during the 1st year of life.000 Total No. It is a good index of the general health condition of a community since it reflects the changes in the environment and medical condition of a community. of registered live births of same calendar year .

childbirth and puerperium. of live births registered of same year y Puerperium- . It is an index of the obstetrical care needed and received by women in a community. Total no. of deaths from maternal causes registered for a given year MMR= _____________________________________x 1000 Total no.Maternal Mortality Rate ² measures the risk of dying from causes related to pregnancy.

Death of the product of conception occurs prior to its complete expulsion. Total no. of live births registered of same year . irrespective of duration of pregnancy. of fetal deaths registered for a given calendar year FDR= __________________________________ x 1000 Total no.Fetal Death Rate ² measures pregnancy wastage.

the rates should be made specific provided the data are available for both the population and the event of their specifications.Neonatal Death rate ² describes more accurately the risk of exposure of certain classes or groups to particular diseases. . Specific rates render more comparable and thus reveal the problem of public health. To understand the forces of mortality.

000 Estimated population as of July 1 in the same Specified class/ group of said year Examples: No.Deaths in specific class/ group registered in a given calendar year Specific Death Rate= _____________________________________ x 100. of death from specific cause registered in a given year Cause Specific Death Rate = ________________________________ x 100.000 Estimated population as of July 1st of the same year .

No.000 Estimated population as of July 1st in the same sex of the same year . of death in a particular age group registered in a given calendar year Age Specific Death Rate = ___________________________________ x 100. of deaths of a certain sex registered in a given calendar year Sex Specific Death Rate = ___________________________________x 100.000 Estimated population as of July 1st in the same age group in the same year No.

No.000 Estimated population as of July of same year . of new cases of a particular disease registered during a specified of time IR = _______________________________x 100.Incidence Rate.measures the frequency of the occurrence of the phenomenon during a given period of time.

of new and old of a certain disease registered at a given time PR = _____________________________________ x 100 Total No. No.Prevalence Rate ² measures the proportion of the population which exhibits a particular disease at a particular time. of persons examined at same given time . This can only be determined following a survey of a population concerned. deals with total (new and old) numbers of cases.

of persons acquiring a disease registered in a given year AR = _______________________________________x 100 No.Attack rate ² a more accurate measure of the risk of exposure No. of exposed to same registered disease in the same year .

of registration deaths from all causes. No.Proportionate Mortality (death ratios) ² shows the numerical relationships between deaths from all causes(or age group causes).. all ages in same year . age(or group of age) etc. of deaths from all causes in all ages taken together. of registered deaths from specific cause or age for a given calendar year PM = ___________________________________ x 100 No. and the total no.

race and any other factors which influence vital events have to be made. By applying specific rates of standard population to corresponding classes or groups of the local population . Methods: 1. sex.Adjusted or Standardized Rate To render the rates of 2 communities comparable. adjustment for the differences in age. By applying observed specific rates to some standard population 2.

of registered cases from same specific disease in same year .index of a killing power of a disease and its influenced by incomplete reporting and poor morbidity date. of registered deaths from a specific disease for a given year CFR = ___________________________________ x 100 No. No.Case Fatality Ratio .

Bar graphs ² each bar represents or expresses a quantity in terms of rates or percentages of a particular observation like causes of illness and deaths. charts and graphs.Presentation of Data observation of events in the community are presented in the form of tables. valleys and seasonal trends. The following are most commonly used in graphs in presenting Data: Line or curved graphs ² shows peaks. . Area Diagram ² (Pie Charts) ² shows the relative importance of parts to the whole. Also used to show the trends of birth and death rates over a period of time.

Functions of the Nurses: 1. 4. 5. Collect data Tabulates data Analyzes and interpret data Evaluates data Recommends redirection and/ or strengthening of specific areas of health programs as needed . 2. 3.

RLE Activities y Computation of demographic data and health indicators of a given community .

Paper and Pencil test y Computation .

PHILIPPINE HEALTH SITUATION y Demographic Profile y Health Profile .B.

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