Community Health Nursing (CHN)

(NSC 300)
(4 Unit)

Olagunju Oluwayemisi.E (RN,MScN)

Department of Nursing Science,
Faculty of Basic Medical Sciences.
Health Agencies
• In nearly every community there are non-
governmental or voluntary agencies that
supplement the work of the ministries of health.
• They include;
• Voluntary Health Agencies
• Public health Agencies
• Private sector health Agencies
• International health Agencies

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Voluntary Health Agencies
The purpose of the voluntary health agency includes the
following components:
• to organize to help each other, especially the unfortunate;
• to study health problems common to many and devise
remedies through research, experiment and
demonstration;
• to sponsor legislation designed to provide permanent
remedy of the problem at hand through official tax
supported health agencies or otherwise;
• to become guardian of the official health agencies,
criticizing, defending, supporting, increasing public
understanding
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and Department
seeingofthat they do the job right.
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Voluntary Health Agencies cont’d
• The wheels of government move slowly.
• The voluntary agency can be prompt and timely.
• The official health agency needs contact with the
people to avoid at least some of the evils of
bureaucracy, and there is no agency to which it can
turn which is better equipped to keep it in step with
public opinion than the voluntary health agency.
• Thus the voluntary agencies, local, state, and
national, become valuable advisors to the official
agency.
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Voluntary Health Agencies cont’d
• they have no selfish motives; they make a unique
impression on elected officials for this very reason.
• They speak for the people who need help and have
facts based on careful studies to support their
demands.
• They act as a public forum for gathering and
disseminating facts, coming to an agreement on what
should be done and obtaining support for getting it
done.
• They therefore complement the official agency, acting
as its supporter,critic, guardian, and advisor.
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Voluntary Health Agencies cont’d
• Almost all voluntary agencies have well-defined programs of
service and health education designed to inform and guide
the public in promoting and maintaining health.
• The program of the agency or its field of interest determines
the emphasis it gives to specific health problems.
• Its interest may be, for example, heart disease, tuberculosis,
cerebral palsy, cancer, or sum clearance. Collectively,
• voluntary agencies make their influence felt in the
enactment, health care for the aged, and health insurance,
all of which are related to the health of the public

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 Voluntary Health Agencies cont’d

• Its most important public health function, is to

assist government agencies in setting and
maintaining high standards of service to people.

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 Non-governmental Organization (NGO)

• This is any non-profit, voluntary citizens' group

which is organized on a local, national or
international level.
• Task-oriented and driven by people with a
common interest.

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• NGOs perform a variety of service and humanitarian
functions;
– bring citizen concerns to Governments
– advocate and monitor policies and encourage political
participation through provision of information
– Some are organized around specific issues, such as
human rights, environment or health
– They provide analysis and expertise
– serve as early warning mechanisms and help monitor
and implement international agreements
– Their relationship with offices and agencies of the United
Nations system differs depending on their goals, their
venue,and the mandate of a particular institution.
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Classes of Non Governmental
Agencies
• Bilateral Organizations
• Multilateral Organizations
Bilateral Organizations

• Bilateral organizations receive funding from

the government in their home countries, and
use the funding to aid developing countries.
• Examples are;
– USAID
– USPHS (Public Health Services)
– CDC (Centre for Disease Control and Prevention)
Multilateral organizations
• Multilateral organizations obtain their funding from
multiple governments and spend it on projects in
various countries
• Examples are:
– World Health Organization
– World Bank
– ADB (African Development Bank)
– Commonwealth Human Rights Initiative (CHRI)
– FAO (Food and Agriculture Organization)
– IFAD ( International Fund for Agricultural Development)
 World Bank
• The global burden of disease is concentrated in
poor countries.
• Ill health is directly related to poverty- it restricts
access to healthcare.
• Comprising about 186 member countries
• Aims to alleviate poverty by giving loan and credits
on advantageous terms not available in the market
• grants to poor countries to initiate various
development projects in education, healthcare,
agriculture, environmental and natural resource
management, infrastructure etc
• UNICEF (United Nations International Children’s
Educational Fund)
• The United Nations International Children’s
Education Fund (UNICEF) works for the welfare of
children across the globe.
• Improving the health of the world’s children is one
of UNICEF’s primary objectives, and it devotes most
of its budget to achieving this goal.
• UNICEF actively implements healthcare projects
abroad- immunization, oral rehydration for babies
with diarrhea, HIV/AIDS education, micronutrient
supplementation etc.
UNDP (United Nations Development Program)

• UNDP creates a partnership between

developing countries and experts with
knowledge and experience in tackling social
issues like HIV/AIDS and poverty.
• UNDP builds local capacity by helping
countries to incorporate best practices and
resources from around the world into national
efforts to combat local problems.
Health Insurance
• This is a type of insurance coverage that covers the
cost of an insured individual's medical and surgical
expenses.
• Depending on the type of health insurance coverage,
either the insured pays costs out-of-pocket and is then
reimbursed, or the insurer makes payments directly to
the provider.
• In health insurance terminology, the "provider" is a
clinic, hospital, doctor, laboratory, health care
practitioner, or pharmacy.
• The "insured" is the owner of the health insurance
policy; the personDepartment
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coverage.
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Two Broad Types of Health Insurance

• Private health insurance

• Public (government) health insurance - for this
type to be called insurance, premiums need to be
collected, even though the coverage is provided
by the state.

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National Health Insurance Scheme(NHIS)

• The decree that enabled The National Health

Insurance Scheme (NHIS) was signed in May 1999.
• Objectives of NHIS are;
– To ensure that every Nigerian has access to
good health care services.
– To limit the rise in the cost of health care
services.
– To ensure equitable distribution of health care
costs among different income groups.
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National Health Insurance Scheme cont’d
Definition
• The Formal Sector Social Health Insurance
Programme is a social health security system in which
the health care of employees in the Formal Sector is
paid for from funds created by pooling the
contributions of employees and employers.
• The Formal Sector consist of the following:
– Public Sector
– Organized Private Sector
– Armed Forces, Police and Allied Services
– Students of Tertiary Institutions and
– Voluntary Contributor
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National Health Insurance Scheme(NHIS)
cont’d
• Guideline for Public Sector and Organized Private
Sector
• Membership
• Employees of the public
• Organized private sector employing ten (10) or
more persons shall participate in the programme.

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National Health Insurance Scheme(NHIS)
cont’d

Contributions
• Contributions are earnings-related.
• The employer pays 10% while the employee pays 5%,
representing 15% of the employee’s basic salary.
• However, the employer may decide to pay the entire
contribution.
• In the organized private sector, an employer may
undertake extra contributions for additional cover to the
benefit package.
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National Health Insurance Scheme(NHIS) cont’d
Waiting Period
• There shall be a processing (waiting) period of sixty (60)
days before a participant can access services.
• Scope of Coverage
• The contributions paid cover healthcare benefits for the
employee, a spouse and four (4) biological children below
the age of 18 years.
• More dependants or a child above the age of 18 would be
covered on the payment of additional contributions from
the principal beneficiary.
• However children above 18 years who are in tertiary
institution
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Department ofunder Tertiary Insurance Scheme.
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• Healthcare providers under the Scheme shall provide the
following benefit package to the contributors:
i) Out-patient care, including necessary consumables;
ii) Prescribed drugs, pharmaceutical care and diagnostic tests
as contained in the National Essential Drugs List and
Diagnostic Test Lists;
iii) Maternity care for up to four (4) live births for every insured
contributor/couple in the Formal Sector Programme;
iv) Preventive care, including immunization, as it applies in the
National Programme on Immunization, health education,
family planning, antenatal and post-natal care;
v) Consultation with specialists,e.g as physicians, pediatricians,
obstetricians, gynaecologists, general surgeons, orthopaedic
surgeons,physiotherapists, etc.
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• Benefit package cont’d
vi) Hospital care in a standard ward for a stay limited to
cumulative 15 days per year, thereafter, the beneficiary
and/or the employer pays.
• However the primary provider shall pay per diem for bed
space for a total 15 days cumulative per year.
vii) Eye examination and care, excluding the provision of
spectacles and contact lenses;
viii) A range of prostheses (limited to artificial limbs produced in
Nigeria); and
ix) Preventive dental care and pain relief (including consultation,
dental health education, amalgam filling, and simple
extraction).
• All Providers are expected to provide counselling as an
integral
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Registration of Employers and Employees
(a) Every employer shall register with the NHIS, upon which a
registration number shall be allotted to it by the Scheme.
(b) Every employer shall appoint an NHIS-registered Health
Maintenance Organisation (HMO) of their choice.
(c) Every registered employer shall supply the following
information to the Scheme and to the appointed HMO:
(i) Name of employer,
(ii) Category of employer (public or private),
(iii) Management structure of the organization, and
(iv) Staff lists, including basic salaries.
(d) The employee shall register self, a spouse and four (4)
biological children below the age of eighteen (18) years with
the Scheme.
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REFERENCES
• http://www.photius.com/countries/nigeria/society/
nigeria_society_primary_health_care_~10006.
• http://circ.ahajournals.org
• International Conference on Primary Health Care, Alma-Ata: twenty-
fifth anniversary. Geneva, World Health Organization, 2003 (Fifty-sixth
World Health Assembly, Geneva, 19–28 May 2003, WHA56.6, Agenda
Item 14.18).
• Principles of Primary Health Care | eHow.com
http://www.ehow.com/about_5502792_principles-primary-health-car
e.html#ixzz185UpvhYS
• Report on the review of primary care in the African Region.
Brazzaville, World Health Organization Regional Office for Africa, 2003.

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