Community Health

Nursing
Lectured by: Z. Famorca, PhD, RN

DOTS
-

Under the office of the president

Many are from Mindanao
Hospice home care
Parish Community Nursing
Faith community nursing

Treatment partner follows up medication

Public health is supposed to be given for free FALSE
PHN appoints a treatment partner
Financing of health services
Another health worker that is accessible
- Out of pocket
BHW
- Health maintenance organization (Phil Health)
3. Population/aggregatefocused
- Free at the point of care
- The greater good of the majority
GovernmentTaxes are paid
- Community Diagnosis
Test taking technique
Vital Statistics
- When choosing numbers choose the middle
ground
Demography
- Do not choose the extreme numbers
- Magnitude (prevalence) of a problem
CHN: Definition
A criterion for priority setting
1. Developmental Services
4. Promotive and preventive
- Development of health capability of Individual,
- Preventive treatment, e.g. DOTS
Family, Group, Community
- Health Education
Groups with common susceptibility
Same working group
5. Pre-paid service
- Enabling service self- reliance
- Taxation (public and school health)
- Health educationdone for health promotion
- Passed on to consumer (occupational)
Patient EducationDone when person
is sick
Transfer of Technology
6. Generalist Practice
- Community organizing
Labor Code: Health, Safety and Welfare Benefits
2. Community-based
- Book 4: Health, safety and welfare benefits
- Catchment
Number of workers
OH services
- Natural environment of people
10-50
Graduate first aider who may be
one of the workers
Home PHN
50-200
Non-hazardous: full-time first
School SHN
aider
Workplace OHN
Hazardous workplace: OHN
3 fields of CHN Practice
- Case-finding of CHN practice
Direct Sputum Smear Microscopy (TB)
Weighing Scale or tape measure for
mid-upper arm circumference
(Malnourishment)
2 types of community:
- Geo political community
Barangay
City
Province
- Phenomenological
GIDA- Geographically Isolated and Deprived Areas
- Cooperative Development Authority

200-300

>300

OHN, Part-time physician and

dentist (at least 2hrs a day),
emergency clinic (1 bed: 100
workers) or hospital within 5 km
Full time DMD and MD

RA 124mandates all schools to have a school clinic for

the treatment of minor ailments and attendance to
emergency cases (1947)
- School health physician reports to the board of
health (DOH)
Functions of OHN and SHN
1. Health care provider
- Promotive and preventive services
Health advocacy
Health education and counseling
Immunization, prenatal care
Margadi
BSN 2013

Treatment of common ailments and emergency

nursing care
CD control
- Screening for health problems:
School health and nutrition survey
done on the 1st visit by the nurse and
every 3 years thereafter
Random/rapid classroom inspection
Annual individual health inspection
o Interview
o Height and weight
measurement
Head to foot examination for
cleanliness, skin disease and other
obvious abnormalities
Visual acuity test: a child with visual
acuity of 20/40 or poorer to be referred
Ear exam and hearing acuity test:
otoscopy, whisper test, ballpen click
test or with the use of tuning fork
(ototoxicity for Streptomycin)
2. Environmental Manager
- Monitoring environmental conditions
- Recognizing and reporting accident and health
hazards in workplace/school
- Healthful school living
- Application of ergonomic principles (physical
environment)
3. Health coordinator
- Making referrals to other agencies and health
personnel
- Coordination with public health nurse, e.g. for
immunization of school children

- Private sector
Philosophy of public health nursing (Margaret Shetland)
- PHN is based on the worth and dignity of man
Contribute to the integrity of the
Individual, Family and Community
- The family is the basic unit of service in PHN
- Physical and emotional health are inseparable
Consider physical and emotional
aspects of the needs of all the members
of the family
Public Health Nursing (WHO expert committee on
nursing)
- PHN is a special field of nursing that combines
the skills of:
Public health
Nursing
Some phases of social assistance
feeding program
4Ps Pantawid pamilyang Pilipino Program
(CCT- conditional cash transfer)
- Poverty alleviation
MDG1: Eliminate hunger and poverty
th
- 5 Quintile and instrument to identify True
Poor
Benefits:
1. P500/month
2. For every qualified child (max of 4 up to 15yrs)
- P300/month for 10 mos.
Conditions:
1. 85% of class days, students should be present
2. Immunization up to the age of 4
3. Children will be in the garantisadong pambata
program
-

Public Health (C.E.Winslow)

Philosophy of public heatlh
- Health and longevity as birth rights
- Premature death (*untimely death)
Objectives of public health
- To prevent disease
- To prolong life
- To promote health and efficiency
Organized community efforts
- People
Primary Health Care
RHU

PHN functions as part of a total public health

program
Health team
1 municipal health plan
- Objectives of PHN
Promotion of health
Improvement of conditions in the
physical and social environment
Rehabilitation
Prevention of illness and disability
Basic competencies of the Public Health Nurse
- Patient care competencies
Margadi
BSN 2013

CHN process
Nursing procedures during clinic and
home visits
Surveillance
- Health promotion and education
- Communication
- Collaboration: community organizing
- Empowering competencies
Legal responsibility
Ethico-moral responsibilities
Personal and professional development
- Enabling competencies
Management of resources and
environment
Record management
- Enhancing competencies
Research
Quality improvement
Level of Prevention
- Target population:
Beneficiaries (For whom?)
Purpose of the nursing action: aspect of
prevention (for what?)
Primary level
- Target population: well individuals, families,
groups and communities
- Aspects of prevention
General health promotion
Specific disease prevention
o Prevent from a single person
Specific protection
o Groups of people
o ASIN Law- An Act for Salt
Iodization Nationwide
Secondary Level
- Target Population: Early sick + subclinical cases
(asymptomatic)
- Aspects of prevention
Early diagnosis and prompt treatment
Prevention of complications
Tertiary Level
- Target population: Late sick: convalescent,
disabled, complicated case, terminal ill

Natural hx of disease
PrePathogenesis
Pathogenesis
Interaction

Millennium Summit: September 6-8, 2000

1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce by2/3 the under 5 mortality rate
(1990:80/1000 live births 2015: 26.7/1000)
5. Reduce by the maternal mortality rate (1990:
2.09/1000 live births 2015: 52/1000 live
births)
6. Combat HIV/AIDS, malaria and other disease
1993: eradication of
1. Polio
2. Neonatal Tetanus
3. Measles
4. Rabies
7. Ensure environmental sustainability
8. Develop a global partnership for development
World Health Organization (MDG4-6)
The Department of Health
Vision- Mission
Vision
To staunch advocate, model and leader of health for all
in the Philippines
A global leader for attaining better health
outcomes, competitive and responsive health
care system, and equitable health financing.

Mission
To guarantee equitable, sustainable and quality health
for all Filipinos, especially the poor, and to lead the
quest for excellence in health.
Roles and functions of the DOH
1. Leader
a. Planner and policy-maker
b. Regulator of health services
c. Advocate in the adoption of health policies,
plans and programs
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BSN 2013

2. Enabler and capacity builder

a. Develop new strategies in health
b. Initiate public discussion on health issues
and disseminate info on research outputs
c. Ensure standards of health promotion,
protection and care (training)
3. Administrator of specific services
a. Manage selected national health facilities
b. Administer direct services for emergent
health concerns that require new
complicated technologies
c. Administer health emergency responses

Universal Health Care

(2010-2016)
FOURmula One for
Health (2005-2010)
Health Sector Reform
Agenda (1999-2004)

Goals
Better Health
outcomes

Responsive
health system

Equitable health
financing

Health care delivery system of the Philippines

Primary Level
- Promotion and prevention
- Management of prevalent conditions
- Out-patient services
Secondary
- Hospitalization
Tertiary
- Specialized care
Specially trained personnel
Highly departmentalized
Sophisticated equipment
National hospitals/DOH national office/ medical
centers/ university hospitals/ special hospitals
Center for health development
Provincial hospital (PHO)

Priority Health Policy Directions of the Aquino

Administration

Prove Health Board

Chair: Governor
Vice-chair: IPHO

District hospital (DHO)

RHU/CHC/CHO

Financial Risk
Protection

BHS

Municipal/city Health Board

Chair: Mayor
Vice-chair: Municipal Health Officer

RA 7160devolution code
Achieving
MDGmax

Health
facilities
enhancement

Universal Health Care

Strategies
1
2
Health Financing Service Delivery
6
Health Human
Resource

5
Health
information

3
Policy and
regulation
4
Governance for
Health

Inter Local Health System

- To ensure quality of health care service at the
local level integrate hospital and public
health services holistic health care
- Inter Local Health Zone (ILHZ)
Clustered municipalities (defined
population within a defined area)
Primary level facilities (RHUs and
BHSs)
Central referral hospital

Margadi
BSN 2013

Components of the ILHZ

- Peoplemay vary, according to WHO, between
100, 000 to 500, 000
- Boundariesto determine accountability of
health service providers
- Health facilities- secondary level hospital
(district of provincial), RHUs BHSs and other
health facilities
- Health workersboth government and nongovernment
Two-way referral system
- Communication among facilities
The RHU team

Margadi
BSN 2013