COMMUNITY HEALTH

NURSING
Content Outline
Part 1 Definition of Terms
Part 2 Basic Principles of CHN
Part 3 Roles and Functions of the PHN
Part 4 Levels of Care
Part 5 Levels of Clientele
Part 6 Health Care Delivery System
Part 7 Primary Health Care
Part 8 Ten Herbal Plants Recommended by
the DOH
Part 9 Family Nursing Process
Part 10 Community Diagnosis
Part 11 COPAR
Part 12 Selected Public Health Situation
Part 13 Vital Statistics
Part 14 Epidemiology
Part 15 Demography
Part 16 Target Setting
Part 17 Environmental Sanitation
Part 18 DOH National Events
PART 1 DEFINITION OF TERMS
A. Public Health
 Science and Art of Preventing Disease, Prolonging Life, Promoting
Health and efficiency through organized community effort for the
sanitation of the environment, control of communicable diseases,
the education of individuals in personal hygiene, the organization
of medical and nursing services for the early diagnosis and
preventive treatment of disease, and the development of social
machinery to ensure everyone a standard of living adequate for
the maintenance of health, so organizing these benefits as to
Enable Every Citizen to Realize His Birthright to Health and
Longevity
- Dr. C.E. Winslow
 Art of applying Science in the Context of Politics so as to Reduce
Inequalities in Health while ensuring the best health for the
greatest number
- WHO
B. Public Health Nursing
 Special Field of Nursing that combines the skills of nursing, public
health, and some phases of social assistance and functions as
part of the total public health program for the promotion of
health, the improvement of the conditions in the social and
physical environment, rehabilitation of illness and disability.
- WHO
C. Community Health Nursing
 Service rendered by a professional nurse with communities,
groups, families, individuals at home, in health centers, in clinics,
in schools, in places of work for the promotion of health,
prevention of illness, care of the sick at home and rehabilitation.
- Ruth B. Freeman
 Nursing Practice in a wide variety of community services and
consumer advocate areas, and in a variety of roles, at times
including independent practice… community nursing is certainly
not confined to public health nursing agencies.
- Jacobson
 The utilization of the Nursing Process in the Different Levels of
Clientele-Individuals, Families, Population Groups and
Communities, concerned with the Promotion of Health,
Prevention of Disease and Disability and Rehabilitation
- Dr. Araceli Maglaya
Part 2 Basic Principles of CHN
A. Brief History of Nursing
 The Community is the patient in CHN; The Family is the Unit of
Care; and there are four levels of clientele: Individual, Family,
Population Group (those who share common characteristics,
developmental stages, and common exposure to health problems
—e.g. children, elderly), and the Community
 In CHN, the client is considered as an Active Partner, not a
passive recipient of care.
 CHN Practice is affected by developments in Health Technology,
in Particular, Changes in Society, in General.
 The goal of CHN is achieved through Multi-Sectoral Efforts
 CHN is a part of the Health Care System and the larger Human
Services System

B. Philosophy of CHN
 A philosophy is defined as a system of beliefs that provides a
basis for a guides action. A philosophy provides the direction and
describes the whats, the whys, and the hows of activities within a
profession.
 CHN Practice is guided by the following beliefs:
Humanistic values of the nursing profession upheld
Unique and distinct component of health care
Multiple factors of health considered
Active participation of clients encouraged
Nurse considers availability of resources
Interdependence among health team members practiced
Scientific and up-to-date
Tasks of CHN vary with time and place
Independence or self-reliance of the people is the end goal
Connectedness of health and development regarded

Part 3 Roles and Functions of the Public Health Nurse

A. Roles of the CHN
  Clinician or Health Care Provider: utilizes the nursing process in
the care of the client in the home setting through home visits and in
public health care facilities; conducts referral of patients to appropriate
levels of care when necessary
 Health Educator: utilizes teaching skills to improve the health
knowledge, skills and attitude of the individual, family and the
community and conducts health information campaigns to various
groups for the purpose of health promotion and disease prevention
 Coordinator and collaborator: establishes linkages and
collaborative relationships with other health professionals, government
agencies, the private sector, non-government organizations and
people’s organizations to address health problems
 Supervisor: monitors and supervises the performance of midwives
and other auxiliary health workers; also initiates the formulation of
staff development and training programs for midwives and other
auxiliary health workers as part of their training function as supervisors
 Leader and Change Agent: influences people to participate in the
overall process of community development
 Manager: organizes the nursing service component of the local health
agency or local government unit; also, as program manager, the PHN is
responsible for the delivery of the package of services provided by the
health program to target clientele
 Researcher: participates in the conduct of research and utilizes
research findings in practice
B. Responsibilities of the CHN
 Be a part in developing an overall health plan, its implementation and
evaluation for communities.
 Provide quality nursing services to the four levels of clientele
 Maintain coordination/linkages with other health team members, NGO/
government agencies in the provision of public health services
 Conduct researches relevant to CHN services to improve provision of
health care
 Provide opportunities for professional growth and continuing education
for staff development
C. Specialized Fields of CHN
 Community Mental Health Nursing: a unique clinical process which
includes an integration of concepts from nursing, mental health, social
psychology, psychology, community networks, and the basic sciences
 Occupational Health Nursing: the application of nursing principles
and procedures conserving the health of workers in all occupation
 School Health Nursing: the application of nursing theories and
principles in the care of the school population
Part 4 Levels of Care
A. The Three Levels of Health Care Services
  Primary Level of Care: devolved to the cities and
municipalities and is the first contact between the community
people and the different levels of health facility; refers to health
care provided by the health center staff
 Secondary Level of Care: rendered by physicians with basic
health training in district hospitals, provincial hospitals, and city
hospitals; these facilities are capable of basic surgical procedures
and simple laboratory examinations; serves as referral center of
primary health facilities
 Tertiary Level of Care: rendered by specialists in medical
centers, regional hospitals and specialized hospitals like the Lung
Center of the Philippines; serves as the referral center of
secondary health facilities
B. Three levels of Health Care Services and the Two-Way Referral
System

National Health
Services, Medical
Centers, Tertiary TERTIARY
Teaching and Training
Hospitals

Regional Health Services,

Regional Medical Centers
and Training Hospital

Provincial/City Health Services, Provincial /City SECONDARY

Hospitals

Emergency / District Hospitals

Rural Health Units, Community Hospitals and Health Centers,

Puericulture centers
PRIMARY
REFERRAL
from the COMMUNITY Barangay Health Station

*There are TWO LEVELS OF PRIMARY HEALTH CARE WORKERS,

namely:
 1. Village or Barangay Health Workers: refers to trained
community health workers or health auxiliary volunteers or traditional
birth attendants or healers
2. Intermediate Level Health Workers: refers to general medical
practitioners or their assistants, public health nurse, rural sanitary
inspectors, and midwives.

C. Types of Primary Health Workers

Village / Grassroots Intermediate Level Health Personnel
Health Workers of First-Line
Hospitals
E - trained community -general medical -physicians
X -health worker practitioners -nurses
A -auxiliary health -public health nurses -dentists
M volunteer -midwives
P -traditional birth
L attendant
E
C -initial link, first -first source of -establishes close
H contact of the professional health contact with the
A community care village and
R intermediate level
A -works in liaison -attends to health health workers to
C with the local health problems beyond the promote the
T service workers competence of village continuity of care
E health workers from hospital to
R -provides community to home
I elementary curative -provides support to
S and preventive the frontline health -provides back-up
T health care workers in terms of health services for
I measures supervision, training, cases requiring
C referral services and hospital or diagnostic
S supplies thru linkages facilities not
with other sectors available in health
care
Part 5 Levels of Clientele
*Four Levels of Clientele in the Community Setting
A. Individual
B. Family
C. Community
D. Population Groups
A. Individual
-basic approaches in looking at the individual
 Atomistic: the whole is equal to the sum of its parts
 Holistic: the whole is NOT equal to the sum of its parts; traces
man’s relationship in the suprasystem of society

B. Family
-defined by Murray and Zentner is a small social system and
primary reference group made up of two or more persons living
together who are related by blood, marriage or adoption or who are
living together by arrangement over a period of time.

C. Population Groups
- a group of people sharing the same characteristics,
developmental stage or common exposure to particular environmental
factors thus resulting in common health problems
* Vulnerable groups:
 Infants and young children
 School age
 Adolescents
 Mothers
 Males
 Older People

D. Community
-a group of people sharing common geographic boundaries
and/or common values and interests

Part 6 Health Care Delivery System

HEALTH CARE DELIVERY SYSTEM
-the totality of all policies, facilities, equipment, products, human
resources and services which addresses the health need, problems and
concerns of the people. It is large, complex, multi-level and multi-disciplinary

MAJOR PLAYERS
 Public Sector- largely financed thru tax-based budgeting system at
both the national and local levels and where health care is generally
given free at the point of service
a. National Level – Department of Health as lead agency
b. Local Health system run by local government units

 Private Sector- largely market-oriented and where health care is paid

through user fees at the point of service

A. THE PUBLIC SECTOR

1. Department of Health
 Vision: The DOH is the leader, staunch advocate and model
in promoting Health for all in the Philippines
 Mission: Guarantee equitable, sustainable and quality health
for all Filipinos, especially the poor, and shall lead the quest
for excellence in health.
 Roles and Functions: Executive Order 102 has identified the
DOH as the national health authority providing technical and
other resource assistance to concerned groups. It has three
specific roles in the health sector and several functions under
each role.
 LEADERSHIP IN HEALTH
Functions:
a. LEADER in the formulation, monitoring and evaluation of
national health policies, plans and programs
b. ADVOCATE in the adoption of health policies, plans and
programs to address national and sectoral concerns
c. NATIONAL POLICY AND REGULATORY INSTITUTION where
local government units, nongovernmental organizations
and other members of the health sector involved in
social welfare and development anchor their thrusts and
directions for health.

 ADMINISTRATOR OF SPECIFIC SERVICES

Functions:
a. MANAGE selected health facilities and hospitals
 b. ADMINISTER direct services for emergent health
concerns that require new complicated technologies
c. PROVIDE emergency health response services including
referral and networking system for trauma, injuries and
catastrophic events, and, in cases of epidemic
widespread public danger upon the direction of the
President and in consultation with the concerned LGU
d. ADMINISTER special components of specific programs
like tuberculosis, HIV-AIDS, etc.

 CAPACITY BUILDER AND ENABLER

Functions:
a. ENSURE highest achievable standards of quality health
care, health promotion and health protection
b. INNOVATE new strategies in health to improve the
effectiveness of health programs
c. INITIATE public discussion on health issues and
disseminate policy research outputs to ensure informed
public participation in policy decision-making
d. OVERSEE implementation, monitoring and evaluation of
national health plans, programs and policies

 Goal of the DOH: Implementation of Health Sector

Reform Agenda (HSRA)
 Framework for the implementation of the HSRA:
FOURmula ONE for Health
a. FOURmula ONE for health intends to implement critical
interventions as a single package backed by effective
management infrastructure and financing arrangements
thru a sector-wide approach
b. This is directed towards ensuring accessible, affordable
quality health care especially for the more
disadvantaged and vulnerable sectors of the population
c. This strategy has FOUR ELEMENTS
1. Good Governance – to enhance health system
performance at the national and local levels.
2. Health Financing – to foster greater, better and
sustained investments in health
3. Health Regulation – to ensure the quality and
affordability of health goods and services
4. Health Service Delivery – to improve and ensure
the accessibility and availability of basic and
 essential health care in both public and private
facilities and services

 Objectives of the Health Sector

- to facilitate understanding the objectives of the health
sector could be divided into 4 general objectives, namely:

Improve Health Status of the Population

a. Improve the general health status of the
population
b. Reduce morbidity and mortality from certain
diseases
c. Eliminate certain diseases as public health
problems
d. Promote health lifestyle and environmental
health
e. Protect vulnerable groups with special
health and nutritional needs

Ensure Quality Service Delivery

a. Strengthen national and local health
systems to ensure better health service
delivery
b. Pursue public health and hospital reforms
c. Reduce the cost and ensure the quality and
safety of health goods and services
d. Strengthen health governance and
management support systems

Improve Support system for the

Vulnerable and Marginalized Groups
a. Institute safety nets for the vulnerable and
marginalized groups

Implement Proper Resource Management

a. Expand the coverage of social health
insurance
b. Mobilize more resources for health
c. Improve efficiency in the allocation,
production and utilization of resources for
health
 Major Health Plans towards “Health in the Hands of
the People in the Year 2020”
 A Healthy BARRIO should be:
a. Residents actively participate in attaining
good health; they are PARTNERS in health
care.
b. Highlight Project: BOTIKA SA PASO
CAMPAIGN
c. Goal: to maintain herbal plants in pots for
family use
A Healthy CITY should be:
a. The physical environment in the workplace,
streets, and public places promote health,
safety, order and cleanliness through
structural manpower support
b. Health- Related Strategies: Construction of
well-maintained, income generating public
toilets; designation of a “pook-sakayan,
pook-babaan”
A Healthy EATING PLACE should be:
a. Eating place where:
-safe and properly prepared, stored and
transferred foods
-nutritious foods and drinks are served.
b. Complies with the following sanitation
standards:
-safe, environment-friendly
-with clean restrooms
-food handlers are medically fit
A Healthy MARKET should be:
a. Adequate water supply
b. Proper drainage
c. Well-maintained toilet facilities
d. Proper garbage and waste disposal
e. Cleanliness maintained
f. Affordable quality foods
A Healthy HOSPITAL should be:
a. A “Center of Wellness”
b. Promotes Preventive care
c. Patient-centered
A Healthy STREET should be:
a. Well-maintained roads and public waiting
areas
b. Clean and obstruction free sidewalks
c. With minimal traffic problems
 d. With adequate strict law enforcement
e. Project: Pook Tawiran
f. Goal: to promote and reorient people
especially erring pedestrians on the use of
pedestrian crossings

2. Local Government Units

-the Local Government Code of 1991 or RA 7160 transformed local
government units into self-reliant communities and active partners
in the attainment of national goals through a more responsive an
accountable government structure instituted through a system of
decentralization

GOVERNOR

Provincial Level Provincial Health

Board
Provincial Health
Office
Provincial Hospital District Hospital Other health and medical
facilities

MAYOR

Municipal Level Municipal Health Board

Municipal Health Office

Rural Health Unit/ Health Barangay Health Station

Center
B. The Private Sector
- composed of both commercial and business organizations with its
market or profit orientation and non-business organizations with its
service orientation
Part 7 Primary Health Care
Primary Health Care – is essential health care made universally
accessible to individuals and families in the community by means
acceptable to them, through their full participation and at a cost that
the community and country can afford at every stage of development

 Conceptual Framework:
a. Health is a fundamental human right
b. Health is both an individual and collective responsibility
c. Health should be an equal opportunity to all
d. Health is an essential element of socio-economic
development

 Translated into action, the PHC APPROACH focuses

on:
Partnership with the community
Equitable distribution of health resources
Organized and appropriate health system infrastructure
Prevention of disease and promotion of health as focus
Linked multisectorally
Emphasis on appropriate technology
 PHC GOAL (1978): Health for all by the year 2000

 PHC was declared in Alma-Ata, USSR during the First

International Conference on PHC held on September 6-
12, 1978 through the sponsorship of WHO and UNICEF

 LEGAL BASIS OF PHC IN THE PHILIPPINES- Letter of

Instruction(LOI) 949 signed in October 19, 1979 by
former President Ferdinand E. Marcos

 UNDERLYING THEME of the Philippine

implementation of PHC: Health in the Hands of the
People by 2020

 5A’s of Health Care according to PHC

a. Available
b. Accessible
 c. Affordable
d. Acceptable
e. Attainable
*PHC as a service delivery policy of the DOH permeates all
strategies and thrusts of government health programs from
the national to the local and community levels
Dimension Commercialized Health Primary Health Care
Care
Goal Absence of disease for the Prevention of disease
individual Socio-economic
development
Focus of Care Sick Sick and well individuals
Setting for Hospital-based Satellite Health Centers
Services Urban-Centered Community Health Centers
Rural-Based
Accessible only to a few Accessible to all
people
People Passive recipients of Active participants in health
health care care
Structure Health is isolated from Inter- and intra- sectoral
other sectors of society linkaging allows health to
be integrated with over-all
socio-economic
development efforts
Process Decision-making from top- Decision-making from
down bottom-top
Technology Curative services based Promotive and preventive
on modern medicine and services blend traditional
sophisticated technology medicine with modern
Physician dominated medicine
Appropriate technology for
frontline health care
Outcome Reliance on health People empowerment or
professionals self-reliance

 Four Cornerstones or Pillars of PHC

Use of appropriate technology
Support mechanism made available
Active community participation
Intra- and inter-sectoral linkage
 a. APPROPRIATE TECHNOLOGY implies the use of
methods, procedures, techniques, equipment or
materials that are not only scientifically sound but also
provides a socially and environmentally acceptable
service or product at the least economic cost
CRITERIA used in determining the
appropriateness of technology:
Acceptability: measured in terms of the degree of
utilization of the people
Complexity: should be simple and easy to apply under
local conditions
Cost: should be affordable
Effectiveness: should produce the desired effect
Safety: effect of utilization should produce no harm
Scope of Technology: serves a variety of purposes
Feasibility: compatible with local conditions

b. MULTISECTORAL APPROACH recognizes intersectoral

and intrasectoral linkages in health. With intersectoral
linkages, PHC recognizes the integration of health plans
with other sectors for TOTAL community development.

 Elements/ Components of Primary Health Care

Communicable disease control
Health education
Expanded program on immunization
Locally endemic disease treatment
Environmental Sanitation
Maternal and child health and family planning
Essential drugs provision
Nutrition and adequate food provision
Treatment of emergency cases and provision of medical
care

Part 8 Ten Herbal Plants Recommended by DOH

10 Medicinal Plants (LUBBY SANTA)

Lagundi
  Indications: cough, asthma, fever, muscle pain
 Preparation: decoction or syrup

Ulasimang Bato
 Indications: lowers serum uric acid in cases of gouty
arthritis
 Preparation: Salad or decoction

Bawang
 Indications: lowers serum cholesterol
 Preparations: may be roasted, soaked in vinegar or used
for sautéing

Bayabas
 Indications: its antiseptic properties is best used for wound
cleansing, as mouthwash in cases of oral cavity infections
and gingivitis
 Preparation: decoction

Yerba Buena
 Indications: for muscle pain
 Preparation: decoction

Sambong
 Indications: its diuretic effect is good for edema and
against urolithiasis
 Preparation: decoction

Ampalaya
 Indications: for diabetes mellitus or non-insulin dependent
diabetes
 Preparation: decoction or steamed

Niyug-niyogan
 Indications: for intestinal infestation with ascaris
lumbricoides
 Preparation: prepare dried, mature niyug-niyugan seeds
Tsaang gubat
 Indications: stomachache
 Preparation: decoction
Akapulko
 Indications: ringworm, tinea flava, athlete’s foot and other
types of fungal infection
 Preparation: poultice or Ointment

*GUIDELINES
 Chemical pesticides or insecticides may leave toxic
residues on plants. These should not be used on herbal
plants
 Use palayok or clay pots and wooden spoon when cooking
herbal medicines, Remove the pot cover when the herbal
preparation starts to boil
 Use only the plant part recommended
 Use the appropriate herbal plant for each sign and
symptom observed
 Watch out for allergic reactions. STOP the use of herbal
plant preparation when allergic and untoward reactions are
observed
 Always keep the herbal medicine containers properly
labeled
 Always keep the herbal preparations out of reach of
children
 RA 8423: utilization of medicinal plants as alternative for
high cost medications
Policies:
 The indications/uses of plants
 The part of plant to be used
 Preparation of herbal medicines

Part 9 Family Nursing Process

 Initial Data base
a. Family structure and characteristics
b. Socio-economic and cultural factors
c. Environmental factors
 d. Health assessment of each member
e. Value placed on prevention of disease

 First Level Assessment

a. Wellness condition – stated as POTENTIAL or READINESS – a
clinical or nursing judgment about a client in transition from a
specific level of wellness or capability to a higher one
b. Health Threats – conditions that are conducive to disease,
accident or failure to realize one’s health potential
c. Health deficits – instances of failure in health maintenance
(disease, disability or developmental lag)
d. Stress Points/ Foreseeable crisis situation – anticipated
periods of unusual demand on the individual or family in
terms of adjustment or family resources

 Second Level Assessment (based on Freeman’s Family

Health Tasks):
a. Ability to recognize the existence of a problem
b. Ability to make decisions with respect to taking appropriate
health actions
c. Ability to provide nursing care to the affected family member
d. Ability to provide a home environment that is conducive to
health maintenance and personal development
e. Ability to utilize community resources for health care

 Problem Prioritization
a. Nature of the Problem
 Wellness condition
 Health deficits
 Health threats
 Foreseeable crisis
b. Preventive Potential – refers to the nature and magnitude
of future problems that can be minimized or totally prevented
if intervention is done on the problem under consideration
c. Modifiability of the Condition – refers to the probability of
success in enhancing the wellness state, improving the
condition, minimizing, alleviating or totally eradicating the
problem through intervention
d. Salience – refers to the family’s perception and evaluation of
the problems in terms of seriousness and urgency of attention
needed
 Scale for Ranking Health Conditions and Problems according to
Priorities

Criteria Score Weight

Nature of the Condition
Wellness State 3
Health Deficit 3 1
Health Threat 2
Foreseeable Crisis 1
Modifiability of the Condition
Easily Modifiable 2
Partially Modifiable 1 1
Not Modifiable 0
Preventive Potential
High 2
Moderate 2 1
Low 1
Salience
A condition needing 2
immediate attention
A condition not 1 1
needing immediate
attention
Not perceived as a 0
condition needing
change

Part 10 Community Diagnosis

A. What is Community Diagnosis?
 As a profile, it is a description of the community’s state of health
as determined by its physical, economic, political and social
 factors. It defines the community and states community
problems
 As a process, it is a continuous learning experience for the
nurse/program coordinator and the staff, as well as the
community people.

B. Why undertake Community Diagnosis?

 To have a clear picture of the problems of the community and
to identify the resources available to the community people.
 Community diagnosis enables the nurse/program coordinator
to set priorities for planning and developing programs of
health care for the community.

C. What are the Types of Community Diagnosis?

The types of a community diagnosis may vary according to:
 The objectives or degree of detail or depth of the
assessment;
 The resources; and
 The time available for the nurse to conduct the
community diagnosis
a. Comprehensive Community diagnosis – aims to
obtain general information about the community or a
certain population
b. Problem-oriented Community diagnosis- type of
assessment that responds to a particular need

D. What are the elements of a Comprehensive Community

Diagnosis?
1. Demographic Variables
-should show the size, composition and geographical distribution
of the population

2. Socio-economic and Cultural Variables

a. Social indicators
b. Economic indicators
c. Environmental indicators
d. Cultural factors
e. Other factors that may directly or indirectly affect the health
status of the community
3. Health and Illness Pattern
-if the nurse has access to recent and reliable secondary data,
then those could be used

4. Health Resources
 -refer to manpower, institutional and material resources provided
not only by the state but also those that are contributed by the
private sector and other non-government organizations

5. Political/ Leadership Patterns

-reflect the action potential of the state and it people to address
the health needs and problems of the community; mirrors the
sensitivity of the government to the people’s struggle for better
lives

E. What are the sources of data in the conduct of the

community diagnosis?
1. Primary Data - source would be the community people through
survey, interview, focused group discussions, observation and
through the actual minutes of community meetings

2. Secondary data – source would be organizational records of the

program, health center records and other public records through
review of records

F. What are the steps in Conducting a Community Diagnosis

1. Planning
a. Determining the Objectives – nurse decides on the depth
and scope of the data he/she needs to gather; regardless of
the type of community diagnosis to be conducted, the nurse
must determine the occurrence and distribution of selected
environmental, socio-economic and behavioral conditions
important to disease prevention and wellness promotion

b. Defining the Study Population – based on the objectives,

the nurse identifies the population group to be included in the
study

c. Preparation of the community – courtesy calls for

meetings are a must to enable the nurse to formulate the
community diagnosis objectives with the key leaders of the
community

d. Choosing the methodology and instrument of

community diagnosis
*Three Levels of Data Gathering
 1. Community People
2. Community health workers
3. Program staff

*INSTRUMENTS may be following:

 Survey questionnaire
 Observation checklist
 Interview guide

2. Implementation
a. Actual data gathering
b. Collation/ organization of data
c. Presentation of data
d. Analysis of data
e. Identifying the community health nursing problems
i. Health Status Problems – may be described in terms
of increased or decreased morbidity, mortality or
fertility

ii. Health Resources Problems - they may be described

in terms of lack of or absence of manpower, money,
materials or institutions necessary to solve health
problems

iii. Health- Related Problems – they maybe described in

terms of existence of social, economic, environmental
and political factors aggravate the illness-inducing
situations in the community
f. Priority- setting of the community Health Nursing
Problems
g. Feedback to the Community – community meetings are
held to inform the community people of the results of the
community diagnosis
h. Action Planning – action programs are the activities
necessitated by the results of the community diagnosis.

3. Evaluation – an evaluation scheme is necessary to measure the

achievements of progress of the program based on the action
plan made through the Community Diagnosis.
Part 11 COPAR
A. Definitions
 A social development approach that aims to transform the
apathetic, individualistic, and voiceless poor into dynamic,
participatory and politically responsive community
 A process by which a community identifies its needs and
objectives, develops confidence to take action in respect to them
and in doing so, extends and develops cooperative and
collaborative attitudes and practices in the community

B. Importance of COPAR
 As important tool for community development and people
empowerment as this helps the community workers to generate
community participation in development activities
 Prepares people/clients to eventually take over the management
of a development program/s in the future
 Maximizes community participation and involvement; community
resources are mobilized for community services

C. Principles of COPAR
 People, especially the most oppressed , exploited and deprived
sectors are open to change, have the capacity to change, and
are able to bring about change
 COPAR should be based on the interests of the poorest sectors of
society
 COPAR should lead to self-reliant community and society

D. Processes/ Methods Used

 A Progressive Cycle of Action- Reflection- Action which
begins with small, local, concrete issues, identified by the people
and the evaluation and reflection of and on the action taken by
them
 Consciousness – RAISING through experiential learning is
central to COPAR process because it places emphasis on learning
that emerges from concrete action and which enriches
succeeding action
 COPAR is Participatory and Mass-Based because it is
primarily directed towards and biased in favor of the poor, the
powerless and the oppressed
 COPAR is Group-centered and not Leader-oriented. Leaders
are identified, emerge and are tested through action rather than
appointed or selected by some external force or entity
 E. Phases of the COPAR Process
1. Pre-Entry Phase
 The initial phase of the organizing process where the
community organizer looks for communities to serve/help
 Designing criteria for the selection of site
 Actually selecting the site for community care
2. Entry Phase
 Sometimes called the social preparation phase as the
activities done here include the sensitization of the people on
the critical events in their life , motivating them to share their
concerns and eventually mobilizing them to take collective
action on these
3. Organization – Building Phase
 Entails the formation of more formal structures and the
inclusion of more formal procedures of planning,
implementing, and evaluating community-wide activities
 Conduct of trainings for the organized leaders or groups to
develop their asks in managing their own concerns/programs
4. Sustenance and Strengthening Phase
 Occurs when the community organization has already been
established and the community members are already actively
participating in community- wide undertakings
 The different committees set-up in the organization-building
phase are already expected to be functioning by way of
planning, implementing and evaluating their own programs,
with overall guidance from the community- wide organization
 Strategies:
*education and training
*networking and linkages
*developing secondary leaders

Part 12 Selected Public Health Programs

Part 13 Vital Statistics
VITAL STATISTICS – the application of statistical measures to vital events
that is utilized to gauge the levels of health, illness and health services of a
community

HEALTH INDICATORS – a list of information which would determine the

health of a particular community like population, crude birth rate, crude
death rate, infant and maternal death rates, neonatal death rates and
tuberculosis death rate

Health Indicators
 Birth
 Death
 Marriages
 Migration

COMMON VITAL STATISTICAL INDICATORS

 Fertility Rates
 Crude Birth Rate
Number of livebirths in a year
= X 1000
Midyear Population, same year
Used often because of availability of data
a. Measures how fast people are added to the population
through birth
b. Crude since it is related to the total population including men,
children and elderly who are not capable of giving birth

 General Fertility Rate

Number of livebirths in a year
=Midyear Population of women15-44 X 1000
years of age
a. More specific than CBR since births are related to the segment
of the population deemed capable of giving birth
b. In some countries, reproductive age groups is 15-49 years of
age

 Age Specific Fertility Rate

Total Births to women age X years
= X 1000
Midyear Population of women age X years
a. Most accurate refinement in the study of fertility
 Mortality Rates
 Crude Death Rate
Number of deaths in a year
= X 1000
Midyear Population, same year
a. Crude because death is affected by different factors
b. Widely used because of availability of data

 Specific Mortality Rate

Number of deaths in specified group

= X 1000
Midyear Population, same year
a. Made specific according to:
 Age
 Sex
 Occupation
 Education
 Exposure to risk factors
 Combination of the above
b. More valid than CDR when comparing mortality experiences
between group

 Cause-of-Death Rate
Number of deaths in specified cause
= X 1000
Midyear Population, same year
a. Crude rate since the denominator includes the whole
population
b. Could be made specific by relating the deaths from a specific
cause and group to the mid-year population of that specific
group

 Infant Mortality Rate

No. of deaths under 1 yr of age
= X 1000
No. of Live births, same year

a. SENSITIVE INDEX of level of health in a community

b. HIGH IMR means LOW LEVELS of health standards secondary
to poor maternal and child health care, malnutrition, poor
environmental sanitation or deficient health service delivery
 c. May be artificially lowered by improving the registration of
births

 Neonatal Mortality Rate

No. of deaths among those under 28 days of age
=No. of Livebirths, same year X 1000

 Post-neonatal Mortality Rate

No. of deaths due to pregnancy, delivery and puerperium
= X 1000
Number of Live Births

 Maternal Mortality Rate

No. of deaths due to pregnancy, delivery and puerperium
= X 1000
Number of Live Births
a. Measures risk of dying from causes associated with childbirth
b. Affected by:
 Maternal health practices
 Diagnostic ascertainment of maternal condition or cause
of death
 Completeness of registration of birth

 Perinatal Mortality Rate

Fetal Deaths, 28 weeks & over of gestation +

= early neonatal deaths, 1 week of age in calendar year

X 1000
Number of Live Births
 Proportionate Mortality Rate

No. of deaths from particular cause

= X 100
Total deaths from all cause, same year
a. Used in ranking cause of death by magnitude of frequency
b. Expressed in PERCENTAGE

 Swaroop’s Index

No. of deaths among those 50 years & over

= X 100
Total Deaths, Same year
a. LOW INDEX implies that life expectancy is short
 b. Directly proportional to the health status of a population,
where developed countries have higher Swaroop’s Index than
developing countries

 Case Fatality Rate

No. of deaths from a specified cause

= X 100
No. of cases of the same disease
a. Measures the killing power of a disease or injury
b. A HIGH CFR means a more fatal disease
c. Rate depends on:
 Nature of the disease
 Diagnostic ascertainment
 Level of reporting in the population
d. CFR from hospitals HIGHER than from the community

 Morbidity Rates
 Incidence Rate
No. of NEW CASES of disease developing from a period of time
= X 100,000
Population in the area during the same period of time
a. Measures the development of a disease in a group exposed to
the risk of the disease in a period of time
b. Can be made specific for age and sex

 Attack Rate
No. of NEW CASES of disease developing from a period of time
=
Population at risk of developing the disease
X 100
during the same period of time
a. Used for a limited population group and time period, usually
during an outbreak or epidemic

 Prevalence Rate
a. Useful in describing the occurrence of chronic conditions and
as basis for making decisions in the administration of health
services
b. Useful also in computing for carrier rates and antibody levels
A. Point Prevalence

No. of existing (Old and New Cases) of a disease at a given time

= X 100
Population examined during that time
 B. Period Prevalence
No. of existing (Old and New Cases) of a
= disease at a given interval time X 100
Population examined during that interval time
INTERPRETATION OF VITAL STATISTICS
Sources of Data
 Vital Registration Records
a. Civil Registry Law or Republic Act No. 3753 requires the
registration of all births and death – c/o National Census and
Statistics Office

b. PD 651 – requires all health workers to register births within 30

days following delivery

 Weekly Reports from Field Health Personnel

 Population Censuses – done every 5 years c/o the National Census
and Statistics Office

GUIDELINES IN THE CLASSIFICATION OF DATA

1. Reckoning of Vital Events – all vital events are registered and
reported by place of occurrence, NOT by place of residence
2. Reckoning of Age – age is recorded as of Last Birthday
3. Classification of Disease and Causes of Death
a. Definition/ Classification of the event in either numerator or
denominator for consistency
b. Accuracy of the count of event or population concerned
c. Use of correct numerator
d. Magnitude / Nature of the rate

Part 14 Epidemiology

EPIDEMIOLOGY – the study of distribution of disease or physiologic

conditions such as deformities or disabilities and even death among human
populations, and the factors affecting such distribution

AIM: to identify factors of causation as basis for determining preventive and

control measures
DESCRIPTIVE PHASE – deals with the collection, organization, and analysis
of data regarding the occurrence of disease other health conditions

A. VERIFICATION OF A DIAGNOSIS
-stating one’s definition of a disease/ diagnosis based on the
presenting signs and symptoms
 Consider Two Factors:
1. Sensitivity – indicates the strength of association between a
sign/ symptom and the disease; picks up most cases and
avoids FALSE NEGATIVES
2. Specificity – shows the uniqueness of the association
between a sign/ symptom and the disease; excludes non
cases or avoids FALSE POSITIVES

B. DESCRIPTION OF THE DISEASE/ CONDITION

 Factors affecting distribution:
1. Place – extrinsic factors
2. Person – intrinsic characteristics such as age, sex, genetic
endowment and other factors such as occupation, place of
residence, income are analyzed to identify susceptible groups
in a certain locality

Factors Affecting the Community’s Reaction to Disease

Agent Invasion
a. Herd Immunity – state of resistance of a population group to
a particular disease at a given time; level of immunity of the
group
b. Susceptibility Status – determined by the number of
individuals with little or no immunity

Patterns of Disease Occurrence

i. Epidemic - a situation when there is a high incidence of
new cases of a specific disease in excess of the expected
ii. Endemic – habitual presence of a disease in a given
geographic location accounting for the low number of both
immunes and susceptible
iii. Sporadic – disease occurs every now and then affecting
only a small number of people relative to the total population
iv. Pandemic – global occurrence of a disease
 3. Time – temporal patterns; expressed on a daily, weekly,
monthly or yearly basis

C. ANALYSIS OF DISEASE PATTERN

-one tries to find out if there is a statistical relationship between a
disease and biological or social factors

 Causal – when there is evidence that shows that certain factors

increase the probability of occurrence of a disease and a change
in one or more of these factors produces a change in the
occurrence of the disease
 Non Causal
a. Spurious – due to chance or bias caused by certain
procedures/ aspects involved in study
b. Indirect – when a factor and disease are associated only
because both are related to some common underlying
condition

Part 15 Demography
A. DEMOGRAPHY
The empirical, statistical and mathematical study of human population;
derived from two Greek word snyos, which means people and ypagly
which means to draw or write

 Focuses on three common and observable human events:

a. Population composition or structure
 b. Distribution of population in space
c. Population size

 Sources of demographic data

a. Census
b. Sample surveys
c. Registration system
Two ways of Assigning People
1. De Jure – people are assigned to places where they
usually live regardless of where they are at the time of
the census
2. De Facto – people are assigned to the place where they
are physically present at the time of the census,
regardless of their usual place of residence
B. COMPONENTS
1. Population Composition – pertains to all measurable
characteristics of the people who make up a given population
a. Sex Ratio
Number of males
= X 100
Number of females

b. Age- dependency Ratio – used as an index of age-induced

economic drain on human resources
No. of persons 0-14 years old + No. of persons aged 65 years and over
= X 1000
No. of persons 15-64 years old

c. Age and Sex Composition – graphical presentation of the age

and sex composition of a population through the use of a
POPULATION PYRAMID

d. Median Age – age below which 50% of the population fall and
above which 50% of the population fall.

e. Life Expectancy at Birth – average number of years an infant

is expected to live under the mortality conditions for a given year

2. Population Distribution
a. Urban – Rural Distribution – shows the proportion of people
living in urban compared to the rural areas
 b. Crowding Index – indicates the ease by which a communicable
disease can be transmitted from one host to another susceptible
host

c. Population Density – determines congestion of the place

3. Population Size
a. Natural Increase – difference between the number of births
and the number of deaths that occurred in a specific population
within a specified period of time

b. Rate of Natural Increase – difference between CBR and CDR of

a specific population within a specified time

Part 16 Target – Setting

TARGET-SETTING
-Involves the calculation of the eligible population for immunization
services. Since the Universal Child Immunization goal of 80% was achieved
in 1989, the target for immunizations since 1992 onwards has increased to
90%. The two most important goals are the following:
 Sustainability of the high coverage and,
 Maintenance of quality immunization Services
A. Eligible Population
1. Infants – for EPI in a barangay, municipality, district, province/city
and region, target setting is based on 3% of the total population

2. BCG School Entrants – use 3% of the total population in

calculating the number of children entering first grade in one year

3. Pregnant Women – All pregnant women are eligible for EPI. Target
Setting must include the number of pregnancies that will terminate
in live births (3% of the total population) plus the number of the
pregnancies (0.5% of the total population); thus, the percentage of
eligible women in the total population is 3.5%

B. Calculating Vaccine Needs

*How to Calculate Vaccine Needs
 Step One : Determine the eligible population
 Step Two: Determine the number of doses required in a year by
multiplying the eligible population with the number of doses for
complete immunization
ANNUAL DOSES NEEDED = Eligible population X No. of Doses

 Step Three: Determine the wastage rate of antigen or use the

wastage multiplier. From step two, multiply the product with the
wastage multiplier to get the annual needs including the wastage
allowance

ANNUAL DOSES WITH WASTAGE ALLOWANCE

= Eligible population X No. of Doses X Wastage Multiplier

 Step Four: Determine the number of ampoules or vials needed

by dividing the annual dose by the dose per vial or ampule

ANNUAL VACCINE NEEDS PER VIAL DOSE = Annual Vaccine / Dose per vial or ampule

 Step Five: Determine the vaccine need per month or quarter

MONTHLY VACCINE NEEDS QUARTERLY VACCINE NEEDS

= Total Vials or ampules / 12 = Total Vials or ampules / 4

months quarters
  Step Six: Determine the vaccine need per month or quarter with
reserve stock

MONTHLY VACCINE NEEDS

= (Total Vials or ampoules / 12 months) X 1.25

C. Determining Needle and Syringe Requirements

*How to Calculate Needle and Syringe Requirements
 Step One: Determine the eligible population
 Step Two: Determine the monthly eligible population

MONTHLY ELIGIBLE POPULATION = Annual eligible population / 12 months

 Step Three: Multiply the monthly eligible population by the

number of doses required for each antigen

MONTHLY INJECTIONS = Monthly eligible population X doses required per antigen

 Step Four: Determine the total requirement including additional

allowance for syringes and needles

TOTAL REQUIRED SYRINGES = Monthly injections X 1.25 for syringes

TOTAL REQUIRED NEEDLES = Monthly injections X 1.50 for needles

Part 17 Environmental Sanitation

ENVIRONMENTAL SANITATION
-is defined as the study of all factors in man’s physical environment which
may exercise a deleterious effect on his health, well-being and survival

GOAL: to eradicate and control environmental factors in disease

transmission through the provision of basic services and facilities to all house
holds

COMPONENTS:
 Water Supply Sanitation Program
 Proper Excreta and Sewage Disposal Program
 Insect and Rodent Control
 Food Sanitation Program
 Hospital Waste Management Program
 Strategies on Health Risk Minimization due to Environmental Pollution

A. Water Supply Sanitation Program

Three Types of Approved Water Supply and Facilities
Level I Level II Level III
Point Source Communal Faucet Waterworks System or
System or Stand Posts Individual House
Connections
A protected well A system composed of a A system with a source, a
or a developed source, a reservoir, a reservoir, a piped
spring with an piped distribution network distributor network and
outlet but without and communal faucets, household taps that is
a distribution located at not more than suited for densely
system for rural 25 meters from the populated urban areas
areas where farthest house in rural
houses are thinly areas where houses are
scattered clustered densely

B. Proper Excreta and Sewage Disposal Program

Three Types of Approved Toilet Facilities

Level 1 Level 2 Level 3

Non- water carriage On site toilet facilities of Water carriage types of
toilet facility the water carriage type toilet facilities
with water sealed and connected to septic
 flushed type with septic tanks and/or sewerage
vault/ tank disposal system to a treatment
facilities plant

C. Proper Solid Waste Management

-refers to satisfactory methods of storage, collection and final disposal
of solid wastes
REFUSE is a general term applied to solid and semi-solid waste
materials other than human excreta. Waste material in refuse may be
divided into:
1. Garbage refers to leftover vegetable, animal, and fish material
from kitchen and food establishments. These materials have the
tendency to decay, thus, giving off foul odor and sometimes also
serve as food for flies and rats
2. Rubbish refers to waste materials such as bottles, broken glass, tin
cans, waste paper, discarded textile materials, porcelain wares,
pieces of metal and other wrapping materials
3. Ashes are leftover from burning of wood and coal. Ashes may
become a nuisance because of the dust associated with them
4. Stable Manure is animal manure collected from stables
5. Dead Animals include dead dogs, cats, rats, pigs and chicken that
were killed by vehicles on streets and public highways
TWO WAYS OF EXCRETA DISPOSAL
Household Community
Burial Sanitary Landfill
Open Burning
Animal Feeding
Composting
Grinding and disposal
sewer

D. Food Sanitation Program

Policies:
1. Food establishments are subject to inspection
2. Comply with sanitary permit requirement for all food
establishments
3. Comply with updated health certificates for food
handlers, helpers, cooks
E. Hospital Waste Management Program
GOAL: to prevent the risk of contracting nosocomial infection and
other diseases from the disposal of infectious, pathological and other
hospital wastes
Policies:
 1. The use of appropriate technology and indigenous materials for
HWM system shall be adopted
2. Training of all hospital personnel involved in waste management
shall be an essential part of the hospital training program
3. Local ordinances regarding the collection and disposal techniques,
especially incinerators, shall be institutionalized

F. Strategies on Health Risk Minimization due to Environmental

Pollution
These include the following:
a. Anti-smoke belching campaign and air pollution campaign
b. Zero solid waste management
c. Toxic, chemical and hazardous waste management
d. Red tide control and monitoring
e. Integrated pest management and sustainable agriculture
f. Pasig river rehabilitation Management
Part 18 DOH National Events
FIRST QUARTER 18- National Diabetes
January 24 Awareness Week
17- Cancer Consciousness Nutrition Month
23 Week National Voluntary Blood Donation
Month
February National Disaster Preparedness
16- Leprosy control week Month
22 Heart Month
Dental Health Month
Campaign on Family THIRD QUARTER
Planning August
March 1 Family Planning Day
24 World TB day 1-17 Mother-Baby Friendly Week
Women’s Health Month 6-12 National Hospital Week
Burn Injury Prevention Month 8-14 Asthma Attack
Rabies Awareness Month 19 National TB Day
Colon and Rectal Cancer Awareness
Month
National Lung Month
SECOND QUARTER Sight-Saving Month
April Lung Cancer Awareness
Month
7 World Health Day
September
Cancer in Children Awareness
Month 26 World Heart Day
May Liver Cancer Awareness
9-15 Safe Motherhood Week Month
23- Health Workplace Week Generics Awareness Month
29 FOURTH QUARTER
31 World No Tobacco Day October
Natural Family Planning 1-7 Elderly Filipino Week
Month 3-9 National Mental Health Week
Cervical Cancer Awareness 3-9 National Newborn Screening
Month
Week
June
10- Health Education Week
5 World Environment Day 16
14 International Blood Donor’s 17- Osteoporosis Awareness
Day 23 Week
23 DOH anniversary 17- Food Safety Awareness
Kidney Month 23 Week
No Smoking Month Breast Cancer Awareness
Dengue Awareness Month Month
Prostate Cancer Awareness National Children’s Month
Month
November
July
7 Food Fortification Day
7-13 Substance Abuse Prevention
Week
14 World Diabetes Day
17 COPD Awareness Day
Traditional & Alternative Health Care Month

December
1 World AIDS Day
10 National Youth health Day
11 World Asthma Day