National Epidemiology Center of DOH, PSA and local

health centers/offices/departments- provide morbidty,

mortality and other health status related data

Local Health Centers/offices/departments-are

responsible for collecting morbidity, mortality data and

forward to higher levels

A. C.E. Winslow – Public Health is science and art of

1. preventing of disease

2. Prolonging life

3. promoting health and efficiency through organized

community effort

Public Health – through organized community effort

- Connotes, organized, legislated, and tax

supported efforts

9 Essential Public Health Functions according to WHO

Regional Office for the Western Pacific:

1. Health Situation monitoring and analysis

2. Epidemiological surveillance/disease prevention and

control

3. Development of policies and planning in public health

4. Strategic management of health systems and services

for population health gain

5. Regulation and enforcement to protect public health

6. Human resources development and planning in public

health

7. Health promotion, social participation and

empowerment

8. Ensuring the quality of personal and population-based

health service

9. research, development, and implementation of

innovative public health solutions

Health Promotion and Levels of Prevention

Health Promotion- activities enhance resources directed

at improving well being

Disease prevention – activities protect people

Leavell and Clark’s Three Level of Prevention

1. Primary Prevention – directed at preventing a problem

before it occurs

- health teaching health education

2. Secondary Prevention- early detection

-problem has begun but before signs and symptoms

appear and titingnan if sinong mga risk factors

3.Tertiary Prevention- have experienced disease and

limits disability and rehabilitation

Community Based Nursing- application of the nursing

process

-setting specific and the emphasis is on acute and chronic

care and includes practice

CHN VS Community Based Nursing

CHN – emphasizes preservation and protection of health

-primary client is the community

Community Based Nursing – emphasizes on managing

acute and chronic

- Primary clients are the individual and family

Population-focused Nursing

-concentrates on specific groups of people regardless

of geographical location

Focused-practice includes

1. focuses on the entire population

2. is based on assessment of the populations health

status

3. considers the broad determinants of health

4. emphasizes all levels of prevention

5. intervenes with communities, systems, individuals

and families

Population-focused nursing

CHN requires the ff types of data for scientific

approach and population:

1. the epidemiology or body of knowledge of a

particular problem and its solution

2. information about the community

Family-basic unit of care

Individual – focus in the clinic or health center

Population- focused approach

The intervention wheel – propose in the late 1990s

by nurses from the Minnesota Department of Health

to describe the breath and scope of public health

nursing practice

3 Important Elements

1. It is population-based

2. It contains 3 levels of practice (community, systems

and individual/family)

3. It identifies and defines 12 public health

interventions

Community Health Interventions

1. Surveillance- monitors health events

2. Outreach- locates populations of interests ex.

Dental mission

3. Screening – identifies individuals with risk factors

\secondary prevention

4. Case Finding – identifies risk factors and connects

them

5. Referral and Follow UP – assists individuals

6. Case Management – optimizes self care

capabilities

7. Delegated Functions- direct care tasks

8. Health Teaching – communicates facts

9. Counselling – establishes interpersonal

relationships to enhance their capacity for self care

and coping

10. Consulation – seeks infos

11. Collaboration – commits two or more persons

12. Coalition Building – develops alliances

13. Community Organizing – identify common

problems or goals

14. Advocacy – pleads someones cause

15. Social Marketing – utilizes commercial marketing

16. Policy Development and Enforcement – place

issues on decision makers

Emerging Fields of CHN in the PH

HOME HEALTH CARE –providing nursing care to

individualsin their own places to minimize the effects

of illness and disability

HOSPICE HOME CARE – homecare renderd to the

terminally ill. Pallative Care is particularly important

ENTREPRENURSE – project by the DOLE in collab with

Board of Nursing in the PH DOH. PNA to promote

nurse entrepreneurship

It aims to:

1. Reduce the cost of healthcare for the countries

indigent population by bringing primary health care

services to poor rural communities

2. Maximize employment opportunities

3. Utilize the countries unemplyed human resources

Main Purpose of ENTREPRENURSE – deliver home

health care services

Competency Standards in CHN

1. SAFE AND QUALITY NURSING CARE- knowledge of

health\illness or status of the client

2. Management of resources and environment –

organization of workload

3. Health Education – assessment of client’s learning

needs

4. Legal Responsibility – adherence to the nursing

laws

5. Ethico-moral Responsibility – respect for the rights

of the client responsibility and accountability for own

decisions

6. Personal and Professional Development – I

dentification of own learning needs

7. Quality Improvement – data gathering for quality

improvement

8. research – research based formulation of solutions

9. Records Management – accurate and updated

documentation

10. Communication – uses therapeutic

communication techniques

11. Collaboration and Teamwokr – establishment of

collaborative relationships

READ THE ACT ACT ACT

Millennium Development Goals (MDG’s) – adopted

during the world summit in September 2000

THE 3 DAY SUMMIT HELD ON 6-8 SEPTEMBER 2000 AT NY

WAS THE LARGEST EVER GATHERING OF WORLD LEADER

- They agreed to achieve a set of concrete,

measurable

- The millenium development goals are the world’s

time bound and quantified targets

Goal 1: Eradicate Extreme poverty and hunger

Goal 2: Achieve universal primary education

Goal 3: Promote Gender Equality and Empower

Women

Goal 4: Reduce Child Mortality

Goal 5: Improve Maternal Health

Goal 6 Combat HIV/AIDS. MALARIA AND OTHER

DISEASES

Goal 7 Ensure environmental sustainability

Goal 8 A global partnership for development

FOURmula One (F1) for Health, 2005 and Universal

Health Care in 2010 – agenda launched in 1999

Elements of HRSA FOURmula one

1. Health Financing

2. Health Regulation

3. Health Service Delivery

4. Good Governance

Universal Health Care – aims to achieve the health

system goals of better health outcomes

Sentrong Sigla Movement

Goal – Quality Health

Objective better and more effective collaboration

between doh and lgus

Pillars

quality assurance -ongoing process of improving

health care services

grants and technical assistance

awards – sentrong sigla movement seal

health promotion – health education

Aquino Health Agenda

– achieving universal health care for all Filipinos

- Kalusugan pangkalahatan

- AO No. 2010-0036

Objective: To achieve universal healthcare

CHAPTER 2 THEORETICAL FOUNDATIONS OF

COMMUITY HEALTH NURSING

FLORENCE NIGHTINGALE – first nurse to formulate a

conceptual foundation for practice

Environmental theory – clean water chuchu

The goal of theory is to improve nursing practice by

acting as a guide

GENERAL SYSTEMS THEORY –

Input – food water energy environment

Output – health conditions / health practices

Feedback – ex. A nurse’s feedback to a mother that

her child is underweight makes the mother more

aware of her childs needs and allows her to take an

action

Social Learning Theory – people learn from one

another

Health Belief Model – individual beliefs

- Perceived susceptibility, perceived severity,

perceived benefits, cues to action, self efficacy

*Milio’s Framework for Prevention – needs are

greater than resources

Penders Health Promotion Model – explores many

biopsychosocial factors

The Transtheoritical Model – changes

- Assumption that behavior change takes place

over time and progresses through stages

Precede – Proceed Model – model for community

assessment

Precede – before or predisposing, reinforcing and

enabling constructs in educational diagnosis and

evaluation

Proceed – stands for policy, regulatory and

organizational constructs that based on precede

Predisposing Factors – peoples characteristics that

motivates

Enabling Factors – conditions in people and the

environment

Reinforcing Factors – feedback given by support

persons

CHAPTER 3 PRIMARY HEALTH CARE

September 6-12, 1978 – first international

conference for PHC at Alma Ata, USSR, Russia

L.O.I 949 – legal basis for PHC in the pH

- signed by pres Ferdinand marcos

THEME- health in the hands of the People by 2020

Definition – the essential care made universally

accessible to individuals and families in the

community through their full preparation . Universal

Goal – health for all by the year 2000

- This is achieved through community and

individual self-reliance

Primary Care – includes health promotion, disease

prevention, health maintenance, counselling, patient

education and diagnosis and treatment of acute and

chronic illness in different health settings.

PRIMARY HEALTH CARE

5 KEY ELEMENTS

1. Reducing exclusion and social disparities in health

(universal coverage)

2. Organizing health services around people’s needs

and expectations (health service reforms)

3. Integrating health into all sectors (public policy

reforms)

4. Pursuing collaborative models of policy dialogue

(leadership reforms)

5. Increasing stakeholder participation

8 Essential Health Services

Education for Health

Locally Endemic disease control

Expanded program for immunization

Maternal and child health including responsible

parenthood

Essential drugs

Nutrition

Treatment of Communicable and non communicable

diseases

Safe water and sanitation

4A’S

ACCESSIBILITY – distance or travel time required to

get to a health care facility

- Home must be within 30 min from the brgy.

Health stations

AFFORDABILITY – consideration of the individual can

afford the services

- In the PH, government insurance is covered

through PHILHEALTH

ACCEPTABILITY – compatible with the culture and

traditions of the population

AVAILABILITY – health service are offered in health

care facilities or is provided on a regular and

organized manner

Ex.

BOTIKA NG BAYAN – ensures the availability of and

accessibility of affordable essential drugs. It sells

lowpriced generic home remedies

Ligtas sa Tigdas sa Pinas 0 mass door to door measles

immunization

- Target – 9 months to below 8 yrs

2 Support Mechanism

3 Major Resources

1. People

2. Government

3. Private Sectors NGO CHURCH

4. Multisectoral Approach

Intra sectoral linkages – two way referral sys.

- Communication, cooperation and collaboration

with the health sectors.

Inter sectoral linkages – between the health sector

and other sectors like education, agriculture and

local gov. officials

5. Community Participation – process in which

people identify problems and needs and assumes

responsibilities

6. Equitable distribution of health resources – 2 DOH

programs to ensure equitable distribution

distribution

DOCTOR TO THE BARRIO DTTB PROGRAM –

deployment of doctors to municipalities that are w/o

doctors

- Deployed to unserved, economically depressed

5th or 6th class municipalities for 2 years

Registered Nurses Health Enhancement and Local Service

RN HEALS – training and program for unemployed nurse

- Deployed to unserved, economically depressed

municipalities for 1 year

RA 8423 – traditional and alternative medicine act of

1997 – TAMA ACT JUAN FLAVIER