OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

Week 1 lesson

7 April 1948 || Geneva, Switzerland.

WHO – Establishment: Established ________ (World Health Day); HQ in ______, ______

WHO – Primary Role

Directs and coordinates international health within the United Nations system.

WHO – Main Areas of Work

Health systems; health through the life-course; noncommunicable & communicable diseases; preparedness, surveillance & response; corporate services.

WHO – Governance

Governed by the World Health Assembly, attended by delegations from all Member States, determines WHO policies.

WHO – Partnerships

Collaborates with countries, UN system, international organizations, civil society, foundations, academia, and research institutions.

WHO – Mission

Builds a better, healthier future; combats communicable diseases (influenza, HIV) and noncommunicable diseases (cancer, heart disease).

Impact of COVID-19 on population health

COVID-19 poses major challenges to population health and well-being globally and hinders progress in meeting the SDGs and WHO’s Triple Billion targets.

2023

Target year for WHO’s Triple Billion goals: 1B healthier lives, 1B with universal health coverage, 1B protected from health emergencies.

1 May 2021

Date when WHO reported over 153M confirmed COVID-19 cases and 3.2M deaths.

153 million

Total confirmed COVID-19 cases reported to WHO as of 1 May 2021.

3.2 million

Total COVID-19 deaths reported to WHO as of 1 May 2021.

Americas & Europe

Most affected regions, accounting for over 75% of global COVID-19 cases.

6114

COVID-19 case rate per 100,000 in the Region of the Americas.

5562

COVID-19 case rate per 100,000 in the European Region.

48%

Share of all COVID-19 deaths occurring in the Region of the Americas.

34%

Share of all COVID-19 deaths occurring in the European Region.

23.1 million

Total COVID-19 cases reported in the South-East Asia Region.

86%

Share of South-East Asia Region cases attributed to India.

High-Income Countries (HICs)

Main concentration of COVID-19 cases globally despite worldwide spread.

20

Number of most impacted HICs that account for nearly half of global cases.

45%

Portion of global cumulative COVID-19 cases from the 20 most impacted HICs.

12.4%

Share of world’s population represented by the 20 most impacted HICs.

Income Inequalities

Exposed by COVID-19 across different income groups.

Global Health Workforce

Stretched capacity due to COVID-19 demands.

Health Information Systems

The area that had Significant gaps revealed by the pandemic.

High-Resource Settings

Faced challenges from overloaded health services.

Low-Resource Settings

Faced critical challenges from weak health systems, risking loss of health and development gains.

66.8 years

Global life expectancy (LE) at birth in 2000.

73.3 years

Global life expectancy (LE) at birth in 2019.

58.3 years

Global healthy life expectancy (HALE) in 2000.

63.7 years

Global healthy life expectancy (HALE) in 2019.

11 years

Increase in life expectancy (LE) in LICs between 2000–2019.

10 years

Increase in healthy life expectancy (HALE) in LICs between 2000–2019.

2019

Year HIV/AIDS and TB dropped out of the top 10 global causes of death.

Tuberculosis (TB)

World’s leading cause of death from a single infectious agent.

2015

Year nations adopted SDG target of Universal Health Coverage (UHC).

Universal Health Coverage (UHC)

Ensures all people receive needed health services without financial hardship.

Healthcare workers

Recognized as crucial to public health capacity; need protection for safety and wellbeing.

Main barriers to UHC progress

• Persistent inequalities

• slowing pace since 2010

• rising financial hardship

• weaker systems in poor and conflict-affected countries

• underprotected healthcare workers.

2021

Designated International Year of Health and Care Workers.

2030

Target year for needing millions more health workers to achieve universal health coverage.

Department of Health (DOH)

The overall technical authority on health; national health policy-maker and regulatory institution.

DOH: Mission

To lead the country in the development of a productive, resilient, equitable, and people-centered health system.

DOH: Vision

Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040.

• Leadership in health

• Enabler and capacity builder

• Administrator of specific services

Roles in the Health Sector

Mandate

To develop national plans, technical standards, and guidelines on health.

Health Service Delivery (Philippines)

The country has a mixed public-private healthcare system operating in a fragmented environment.

National Health Insurance Act of 1995

• Created PhilHealth to provide health insurance coverage for all Filipinos

• Enrolment not compulsory at first

2013 Amendment

• Expanded NHIP coverage to include:

  • Underprivileged

  • Sick

  • Elderly

  • Persons with Disabilities (PWDs)

  • Women & children

• Strengthened role of LGUs & health providers in NHIP enrolment

C. E. Winslow

Defined public health as the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort.

Public Health – Key Elements (Winslow)

1. Sanitation of the environment

2. Control of communicable infections

3. Education in personal hygiene

4. Organization of medical and nursing services for early diagnosis and preventive treatment

5. Development of social machinery to ensure adequate living standards for health

Community Health

A term used to describe the state of health and how easy or difficult it is to be healthy where people live, learn, work, and play. It includes access to medical care and resources for exercise and healthy habits, which are important for emergency planning and improving outcomes before, during, and after a public health emergency. (CDC)

Public Health Nursing

• A component or subset of Community Health Nursing (CHN).

• The synthesis of public health and nursing practice.

Public Health Nursing

• Defined as the field of professional practice in nursing and public health where technical nursing, interpersonal, analytical, and organizational skills are applied to community health problems. These are used alongside other health workers through:

  • comprehensive nursing care of families and groups,

  • evaluation and control of health threats,

  • health education of the public,

  • mobilization of the public for health action. (Freeman, 1963)

Community Health Nursing (ANA, 1980)

• The synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations.

• A broader and more general specialty area that encompasses subspecialties, including public health nursing, school nursing, occupational health nursing, and other developing fields of practice such as home health, hospice care, and independent nurse practice.

Safe and Quality Nursing Care

Knowledge of health/illness status of the client, sound decision making; ensures safety, comfort, privacy, proper administration of medications and therapeutics, and application of the nursing process.

Management of Resources and Environment

Organization of workload; proper use of financial resources for client care; ensures proper functioning of equipment and maintenance of a safe environment.

Health Education

Assessment of client’s learning needs; development, implementation, and evaluation of a health education plan and learning materials.

Legal Responsibility

Adherence to nursing laws and national, local, and organizational policies, including accurate documentation of care provided to clients.

Ethicomoral Responsibility

Respect for client rights; accountability for own decisions and actions; adherence to international and national codes of ethics for nurses.

Personal and Professional Development

Identification of own learning needs; pursuit of continuing education; maintaining a professional image; positive attitude toward change and constructive criticism.

Quality Improvement

Gathering data for quality improvement; participation in nursing rounds; identification and reporting of solutions to problems related to client care.

Research

Using research-based approaches to formulate solutions to client care problems; dissemination and application of research findings.

Records Management

Accurate and updated documentation of client care while complying with legal requirements and proper record-keeping.

Communication

Uses therapeutic communication techniques, identifies verbal and nonverbal cues, responds to client needs, and utilizes formal/informal channels and appropriate information technology.

Collaboration and Teamwork

Establishment of collaborative relationships with colleagues and other members of the health care team.

1577

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Franciscan Friar Juan Clemente opened a medical dispensary in Intramuros for the indigent.

1690

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Dominican Father Juan de Pergero worked toward installing a water system in San Juan del Monte and Manila.

1805

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Smallpox vaccination was introduced by Francisco de Balmis, the personal physician of King Charles IV of Spain.

1876

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• First medicos titulares were appointed by the Spanish government.

1888

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Two-year courses consisting of fundamental medical and dental subjects were first offered at the University of Santo Tomas.

• Graduates, known as “cirujanos ministrantes,” served as male nurses and sanitation inspectors.

1901

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• The United States Philippines Commission, through Act 157, created the Board of Health of the Philippine Islands with a Commissioner of Public Health as its chief executive officer (now the Department of Health).

Fajardo Act of 1912

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Created sanitary divisions made up of one to four municipalities.

• Each sanitary division had a president who had to be a physician.

1915

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• The Philippine General Hospital began to extend public health nursing services in patients’ homes by organizing a unit called Social and Home Care Services.

Asociacion Feminista Filipina (1905)

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Lagota de Leche was the first center dedicated to serving mothers and babies.

1947

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• The Department of Health was reorganized into bureaus: quarantine, hospitals (which took charge of municipal and charity clinics), and health, with sanitary divisions under it.

1954

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Congress passed RA 1082, the Rural Health Act, which provided for the creation of Rural Health Units (RHU) in every municipality.

RA 1891 (1957)

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Amended certain provisions in the Rural Health Act.

• Created 8 categories of rural health units corresponding to the population size of municipalities.

RA 7160 (Local Government Code, 1991)

EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES:

• Amended the devolution of basic health services, including health services, to local government units.

• Established a local health board in every province, city, and municipality.

Millennium Development Goals

Adopted during the World Summit in September 2000.

FOURmula One (F1) for Health, 2005 and Universal Health Care in 2010

Agenda launched in 1999.

Universal Health Care

Aims to achieve the health system goals of better health outcomes, sustained health financing, and a responsive health system that will provide equitable access to health care.

Health Promotion

The main focus of community health nurse is _____________

Programmer/Planner

• Identifies the needs and concerns of individuals, groups, families, and the community

• Formulates health plans, especially in the absence of a community physician

• Interprets and implements nursing plans and programs

• Assists other health team members in implementing health programs in the setting

Health Educator/Trainer/Counsellor

• Acts as resource speaker on health and health-related services

• Advocates health programs in the community through dissemination of IEC materials

• Conducts advocacy education concerning premarital, breastfeeding, and immunization counselling

• Organizes orientation/training of concerned groups like pregnant mothers

• Identifies and interprets training needs of health team members and formulates appropriate training programs for them

• Conducts and facilitates necessary training or educational orientation to other health team members in the community

Community Organizer

• Promotes self-reliance of the community and emphasizes their involvement and participation in planning, organizing, implementing, and evaluating health services

• Initiates and implements community development activities

Coordinator of Services

• Coordinates health services with concerned individuals and families through community health team members, government organizations, and NGOs

• Coordinates nursing plans and programs with other health programs

Provider of Nursing Care

• Renders direct care to various clients with different needs at home, in school, clinics, or work settings

• Involves the family in the care of the sick or dependent individual, e.g., a sick child

Health Monitor

• Monitors and detects the presence of health concerns in the community through contacts or home visits

• Utilizes various effective data gathering techniques to keep track of the health status of all recipients of care

• Records and reports health status and presence of health problems in the community

Researcher

• Follows a systematic process of monitoring the health status of the community through surveys and home visits

• Conducts research concerning the health of the community

• Coordinates with government and non-government organizations in the conduct and implementation of studies

Statistician

• Records data systematically and ensures its validity through accurate and complete data gathering

• Prepares and reports findings to concerned organizations, e.g., government organizations, for necessary plans or programs

• Consolidates and reviews reports efficiently

• Analyzes and interprets consolidated data for monitoring developments in community health matters

Change Agent

• Promotes and motivates change in the community’s health practices and lifestyle behaviors to maintain good health

• Encourages self-reliance to bring about development and improvement in the community