CHN  It is the synthesis of nursing knowledge and practice and

COMMON WORDS USED IN COMMUNITY the science of public health, implemented via a
HEALTH NURSING systematic use of the nursing process and other
Community processes to promote health and prevent illness in
 A collection of people who interact with one another and population groups (Clark, 2005).
whose common interests or characteristics form the
basis for a sense of unity or belonging (Allender et.al, STANDARDS OF PUBLIC HEALTH NURSING
2009). PRACTICE
 A group of people who share common interests, who
interact with each other and who function collectively Standards of Care
within a defined social structure to address common Standard 1: Assessment
concern (Clark, 2008).  The PHN/CHN collects comprehensive data relevant to
 A group or collection of individuals interacting in social the health status of the community.
units ns sharing common interests, characteristics,
values and goals (Maurer and Smith, 2013). Standard 2: Population Diagnosis and Problems
 The CHN/PHN analyzes the assessment data to
Health
determine the population diagnoses and priorities.
 A state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity
Standard 3: Outcomes Identification
(WHO, 1947)
 The CHN/PHN identifies expected outcomes for a plan
that is based on population diagnoses and priorities.
Public Health
The science and art of preventing disease prolonging life and
Standard 4: Planning
promoting health and efficiency through:
 The CHN/PHN develops a plan that reflects the best
 organized community effort for the sanitation
 control of communicable diseases practices by identifying appropriate strategies, action
 education of individuals in personal hygiene plans, and options to attain expected outcomes.
 organization of medical and nursing services for the
early diagnosis and preventive treatment of disease Standard 5: Implementation
 development of social machinery to ensure everyone a  The CHN/PHN implements the identified plan by
standard of living adequate for the maintenance of partnering with other
health, so organizing these benefits as to enable every a) Coordination – coordinates programs, services
citizen to realize his birthright to health and and other activities to implement the identified plan
longevity. (Dr. Charles-Edward Winslow, 1920) b) Health Education and Health Promotion –
employs multiple strategies to promote health,
Community Health prevent diseases and ensure a safe environment for
 It is the environmental, social, and economic resources the community.
to sustain emotional and physical well-being among c) Consultation – provides consultation to various
people in ways that advance their aspirations and satisfy
community groups and officials to facilitate the
their needs in their unique environment (WHO).
 The health status of a community and the organized
implementation of programs and services.
responsibilities of public health, school health, d) Regulatory Activities – identifies, interprets, and
transportation, safety and other tax-supported functions implements public health laws, regulations and
with voluntary and private actions to promote and policies.
protect the health of local populations identified as
communities (Green and Ottoson, 1999). Standard 6: Evaluation
 The CHN/PHN evaluates the health status of the
Public Health Nursing population/community.
 It is the practice of nursing in national and local
government health departments and public schools. It is Standards of Professional Performance
community health nursing practiced in the public sector Standard 7: Quality of Practice
(Standards of Public Health Nursing in the Philipines,  The CHN/PHN systematically enhances the quality and
2005). effectiveness of nursing practice.
 It is the practice of promoting and protecting the health
Standard 8: Education
of populations using knowledge from nursing, social
 The CHN/PHN attains knowledge and competency that
and public health sciences (American Public Health
Association, 1996) reflects current nursing and public health practices.
Community Health Nursing Standard 9: Professional Practice Evaluation
 It is service rendered by a professional nurse to  The CHN/PHN evaluates one’s own nursing practice in
communities, groups, families and individuals at home, relation to professional practice standards and
in health centers, in clinics, in schools, and in places of guidelines, relevant statutes, rules and regulations.
work for the promotion of health, prevention of illness, Standard 10: Collegiality and Professional Relationships
care of the sick at home, and rehabilitation. (Ruth B.  The CHN/PHN establishes collegial partnership while
Freeman) interacting with representatives of the population,
 A synthesis of nursing practice and public health applied organizations and health and human service
to promoting and preserving the health of the professionals.
populations. The focus of community health nursing:  Contributes to the professional development of peers,
(1) prevention of illness, (2) promotion of health and (3) students, colleagues, and others.
maintenance of health. (American Nurses Association,
1980).
Standard 11: Collaboration 4) Health Educator
 The CHN/PHN collaborates with representatives of the  health education is one of the most frequently used
population, organizations and health and human services intervention by the nurse.
professionals in providing for and promoting the health  Initiates the use of tri-media (radio/TV, cinema
of the population. plugs, and print ads) for health education purposes

Standard 12: Ethics 5) Counselor

 The CHN/PHN integrates ethical provisions in all areas  Giving support to personal problems
of practice.
6) Client/Patient Advocate
Standard 13: Research  Intercedes and pleads the cause of another
 The CHN/PHN integrates research findings in practice. (client/patient)

Standard 14: Resource Utilization Population 7) Change Agent

 The CHN/PHN considers factors related to safety,  Motivates changes in health behavior in
effectiveness, cost and impact on practice and in the individuals, families, groups, and communities that
planning and delivery of nursing and public health also include lifestyle in order to promote and
programs, policies and services. maintain health
Standard 15: Leadership
 PHN provides leadership in nursing and public health. 8) Community Organizer
 Stimulates and enhances the community’s
ROLES, RESPONSIBILITIES, FUNCTIONS AND participation in planning, organizing, implementing
COMPETENCIES OF THE COMMUNITY HEALTH and evaluating health programs & services.
NURSE  Motivates and enhances community participation in
terms of planning, organizing, implementing, and
evaluating health services
 Initiates and participates in community
development activities

9) Team Member
 As member of the health team

10) Trainer, Supervisor, Manager

 Identifies and interprets training needs of the
RHMs, Barangay Health Workers (BHW), and
hilots
Role  Conducts training for RHMs and hilots on
 is a sociological concept which refers to the behavior promotion and disease prevention
prescribed & expected of all who perform certain  Conducts pre and post-consultation conferences for
functions. clinic clients; acts as a resource speaker on health
 An individual assumes a role in different circumstances. and health related services

Various Roles of a Community Health Nurse 11) Researcher

1) Health Monitor  Plans and conduct of nursing & related studies that
 Detects deviation from health of individuals, families, contribute to the improvement of nursing & health
groups, and communities through contacts/visits with services.
them  Participates in the conduct of survey studies and
 monitors more effectively concepts of illness among researches on nursing and health-related subjects
family members.  Coordinates with government and non-government
organization in the implementation of
2) Provider of Care to the Sick and Disabled studies/research
 Provides direct nursing care to sick or disabled in
the home, clinic, school, or workplace 12) Role Model
 Develops the family’s capability to take care of the  Provides good example of healthful living to the
sick, disabled, or dependent member members of the community

3) Coordinator of Family Services 13) Planner/Programmer

 the nature of health problem requires services of  Identifies needs, priorities, and problems of
other disciplines nurse. individuals, families, and communities
 Coordinates with individuals, families, and groups  Formulates municipal health plan in the absence of
for health related services provided by various a medical doctor
members of the health team  Interprets and implements nursing plan, program
 Coordinates nursing program with other health policies, memoranda, and circular for the concerned
programs like environmental sanitation, health staff personnel
education, dental health, and mental health  Provides technical assistance to rural health
midwives in health matters
RESPONSIBILITIES OF A COMMUNITY HEALTH Competency Standards in Community Health Nursing
NURSE  Safe and quality nursing care
Responsibility  Management of resources and environment
 the obligation to perform duties, tasks or roles using  Health education
sound professional judgement and being answerable for  Legal responsibility
the decisions made in doing this.  Ethico-moral responsibility
 A nurse who is considering expanding their scope of  Personal and professional development
practice should realize that this will involve greater  Quality improvement
responsibility.  Research
 Records management
Responsibilities of a Community Health Nurse  Communication
 Providing care to the sick  Collaboration and Teamwork
 Maintaining healthy environment
 Teaching THE HEALTH CARE DELIVERY SYSTEM
 Identify the needs and referring the clients/patients
LEVELS OF CLIENTELE IN THE COMMUNITY
for service
1. Individual
 Preventing and reporting neglect and abuse  nurses provide care to specific clients/patients
 Advocating  from being healthy/well - dying
 Collaborating  from birth - senescence
 Participating in professional development activities  considered as “Entry Point” in working with
 Engaging and ensuring quality nursing research families/community
 FOCUS of Care = the "person"

FUNCTIONS OF A COMMUNITY HEALTH NURSE 2 Approaches (Ways of Looking at the Individual)

Function a. Atomistic Approach
 a set of activities and tasks expected of a person by  views man as an organism composed of different
virtue of his position or role in the society. organs systems (parts) which in order to function
properly, they have to be properly organized at
Activity
different levels.
 is a combination of specific tasks whose fulfillment
Levels of Organization:
leads directly to the performance of a function.
 Chemical Level
Task
 Organelle Level
 is a piece of work assigned or done as part of one's
duties.  Cellular Level
 Tissue Level
 Organ Level
“Activities” and “Tasks” -are units of a function
 System Level
b. Holistic Approach
Function: Assess the physical & mental health status of
 views man a whole organism with interrelated and
clients and their family in a depressed area.
interdependent parts functioning to produce behavior
(acceptable or unacceptable) to the society
Activities: 5 Dimensions of Man
a) Data gathering  Physical
b) History tasking  Intellectual
c) Assessment of nutritional status of children  Social
 Spiritual
Tasks:  Emotional
a) Inspect the home environment
b) Conduct interview/home visit Objectives of nursing care:
c) Obtain weight, meal plan, etc. 1. Promotion & maintenance of health
2. Prevention of disease, early diagnosis and treatment of
COMPETENCIES OF A COMMUNITY HEALTH a suspected ailment
NURSE 3. Recovery and/or rehabilitation from illness
COMPETENCY 4. Self-reliance in personal care, or peaceful, dignified
 the ability to do something successfully or death.
efficiently.
COMPETENCE 2. FAMILY
 basic unit of society
 quality of being functionally adequate in performing
 refers to 2 or more individuals joined or related by
the tasks and assuming the role of a specific position.
ties of blood, marriage or adoption and who
constitute a single household
Competencies Required of a Community Health Nurse  interact with each other in their respective familial
1) Technical Skills roles & who create and maintain a common culture.
2) Human Relations Skills 3. POPULATION GROUP /AGGREGATES
3) Communication Skills  A group of people sharing the same characteristics,
4) Teaching Skills developmental stage or common exposure to
5) Management Skills particular environmental factors (Clark, 1999 as
cited in Maglaya)
 common health problems
 examples: children, women, farmers, elderly
4. COMMUNITY PUBLIC HEALTH IN THE PHILIPPINES
 A group or collection of individuals interacting in Definition: Public Health
social units ns sharing common interests, The science and art of preventing disease prolonging life
characteristics, values and goals. and promoting health and efficiency through:
 Community as a whole is the client to whom the  organized community effort for the sanitation
nurse delivers nursing services addressed to the  control of communicable diseases
community- wide health problems.  education of individuals in personal hygiene
 organization of medical and nursing services for the
WORLD HEALTH ORGANIZATION early diagnosis and preventive treatment of disease
 193 member countries  development of social machinery to ensure everyone a
 WHO is directed towards providing technical standard of living adequate for the maintenance of
collaborations with member states in accordance with health, so organizing these benefits as to enable every
each country's needs and capacities. citizen to realize his birthright to health and longevity.
 The Philippines is a member of the Western Pacific
Region which holds office in Manila (WHO, 2007 as
cited by Famorca)

OBJECTIVE: The attainment by all people of the highest

possible level of health.

CORE FUNCTIONS OF WHO

Leadership
 Provide leadership on matters critical to health and
engage in partnerships where joint action is needed.
Research
 Shape the research agenda and facilitate translation and Core Functions of Public Health
disseminate valuable knowledge 1. Assessment
Quality Assurance  Monitor health status to identify community health
 Set norms and standards for health and health related problems
issues  Diagnose and investigate health problems and health
 Promote and monitor their implementation hazards in the community
Ethics  Evaluate effectiveness, accessibility, and quality of
 Articulate ethical and evidence-based policy options personal and population-based health services
Technical Support
 Provide technical support and training to its member 2. Policy Development
countries  Develop policies and plans that support individual
 Monitor health situations and assess health trends and community health efforts
 Develop guidelines and tools on measurement,  Enforce laws and regulations that protect health and
monitoring and evaluation ensure safety.
 Research for new insights and innovative solutions
to health problems

3. Assurance
 Link people to needed personal health services and
assure the provision of health care when otherwise
unavailable
 Assure a competent public health and personal health
care workforce
 Inform, educate, and empower people about health
issues
 Mobilize community partnerships to identify and
solve health problems
Public Health Interventions
INTERVENTION DEFINITION
Surveillance Describes and monitors health events through systemic collection
Case Finding Locates individuals and families with identified risk factors and connects them with resources
Health Teaching Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs and practices of
I, F, P and C
Screening Identifies individuals with unrecognized health risk factors and connects them with resources
Referral and Assist individuals, families, groups, and communities to identify necessary resources to prevent/resolve
Follow-up concerns.
Established an interpersonal relationship with a family, community or system to enhance capacity for
Counseling
self-care and coping
Collaboration Commits 2 or more persons or an organization to achieve a common goal
Community Helps community groups to identify common problems or goals mobilize resources and implement
Organizing strategies
Advocacy Pleads someone’s cause or acts on someone’s behalf to develop a community
HEALTH CARE DELIVERY SYSTEM Goal of DOH:
Health Care Delivery System (HCDS)  Implementation of health sector reforms through
 totality of all policies, facilities, equipment, products, the HEALTH SECTOR REFORM
human resources and services which addresses the AGENDA (HSRA) areas.
health need, problems and concerns of the people.
 multi-level and multidisciplinary Functions and Responsibilities of DOH: (National
Level)
Major Players Leadership
1. Public sector  Policy making
a. National level - Department of Health (DOH)  Monitoring and evaluating implementation of health
b. Regional and Provincial Level - Local health programs
system run by LGU  Advocating for health promotion activities
c. Municipal or City Level - Local health system run  Serving as technical authority in disease control
by LGU  Provides administrative and technical leadership in
2. Private sector health care financing (National Health Insurance Law)
 composed of both commercial and business
organization with its profit or market orientation Administrator of Specific Services
and non-business organizations with its service  Serve as administrator of selected health facilities at
orientation (NGOs) subnational levels (referral centers)
 Provide specific program components for conditions
1. Public sector: that affect large segments of the population
A. National level (Department of Health)  Develop strategies for responding to emerging health
 Kagawaran ng Kalusugan needs
 is the leader, staunch advocate and model in promoting  Provide leadership in health emergency preparedness
Health for All (HFA) in the Philippines. and response services
 responsible for ensuring access to basic public health
services by all Filipinos through the provision of quality Capacity Builder and Enabler
health care and the regulation of all health services and  Provide logistical support to LGUs, the private sector
products and other agencies implementing health programs and
 E.O. #102 (1999) – National Health Authority service
 Serve as the lead agency in health and medical research
VISION  Protect standards of excellence in the training and
 Filipinos are among the healthiest people in Southeast education of health care providers at all levels
Asia by 2022, and Asia by 2040.
B. Regional/Provincial Level
MISSION Functions and Responsibilities of Regional and
 To lead the country in the development of a productive, Provincial Level
resilient, equitable and people-centered health system.  Formulation of more detailed or specific policies/ plans
to suit local conditions
 Translate plans into action
FRANCISCO DUQUE III – DOH Secretary  Conduct of orientation program for new staff
1st Term - June 2005 - January 2010  In service training for nursing personnel on the job
2nd Term – October 2017 - present  Planning & implementation of supervision program for
CHN personnel
Historical Background of the Department of Health  Assessment / evaluation of performance of CHN
1901 – 1909 – Establishment of health institutions by personnel in the health centers
Americans  Implementation of standards for CHN practice
1915 – Bureau of Health then later on changed to Phil.  Quality control checks
Health Service.  Preparation of reports
1933 – Establishment of Community Health and Social
Centers under Dr. Jose Fabella currently known as Brgy. Organizational Structure of the Provincial Level
Health Centers
1940’s – Department of Health and Public Welfare Governor
Priorities: TB, Malnutrition, Malaria, Leprosy, GI dx, high
infant mortality rates Provincial Health
1958 – Creation of 8 Regional Health Offices Board
1975 – 1980’s – 3 institutions were built
 Philippine Heart Center
 National Kidney and Transplant Institute Provincial Health
 Lung Center of the Philippines Office
2019 – UHC Act of 2019
2020 – DOH under Sec. Duque

Major Roles of DOH: District Other Health and

Public sector: National Level (Department of Health) Hospitals Medical Facilities
Major Roles:
 Leadership in Health Provincial Municipal Health
 Administrator of Specific Service Hospitals Office
 Capacity Builder
 Enabler
C. Municipal or City Level 2 WAY REFERRAL SYSTEM
 Local health system run by LGU Community - - - - - - - - - - - - - - - - - - |
 Local Government Code of 1991 or Republic | |
Act No . 7160 mandates Devolution of powers, BHS ------------------|
functions and responsibilities to LGUs in terms of | Primary Care |
provision and delivery of basic health services. RHU - - - - - - - - - - - - - - - - - - - > Private Hospital
Devolution – refers to the act by which the national | Primary Care |
government confers power and authority upon the various Municipal District/ City Hospital - - |
LGU’s to perform specific functions and responsibilities. | Secondary Care |
Provincial Hospital - - - - - - - - - - - - |
Functions and Responsibilities of the Municipal or City | Secondary/Tertiary Care
Level Medical Regional Center (Tertiary Care)
 implementation level of the CHN program by
the nursing team in the health center.

Organizational Structure of the Municipal or City Level

Office of the Mayor

City/ Municipal
Health Board

City/ Municipal
Health Office

Rural Health Unit/

Barangay Health
Health Center
Station

LEVELS OF HEALTH CARE FACILITIES

DOH Administrative Order 2012-0012A
 “Rules and Regulations Governing the New Classifications of Hospital and Other Health Facilities in the Philippines”

GENERAL HOSPITALS

Hospitals Level 1 Level 2 Level 3

Level 2 + Teaching/Training
Consulting specialist in:
Clinical Services for Level 1 + Departmentalized with accredited residency
Medicine, Pediatrics, OB-Gyne
in-patients Clinical Services training program in 4 major
Surgery
clinical services
Physical Medicine and
Emergency and OPD Services Respiratory Unit
rehabilitation Unit
Isolation Facilities General ICU
Surgical/Maternity Facilities High Risk Pregnancy Unit Ambulatory surgical clinic
Dental Clinic NICU Dialysis Clinic
Tertiary clinical laboratory with
Ancilliary services Secondary clinical laboratory Tertiary clinical laboratory
Histopathology
Blood Station Blood Bank
1st Level X-ray 2nd Level X-ray with mobile Unit 3rd Level X-ray
Pharmacy

OTHER HEALTH FACILITIES

HOSPITALS OTHER HEALTH FACILITIES

General Cat. A :Primary Care Facility

Level 1 Cat B : Custodial Care Facility
Level 2 Cat. C : Diagnostic/Therapeutic Facility
Level 3 (Teaching/Learning)
Specialty Cat. D : Specialized Outpatient Facility
Category A: Primary Care Facility PRIMARY HEALTH CARE: An Approach To
 Are the rural health units/birthing (lying-in) clinics Community Health
 first contact health care facility Brief History
 Health services offered at this level are to individuals in ----
fair health and to patient with disease in the early International Conference for Primary Health
symptomatic stages. Care (WHO and UN Children’s Fund)
 with in-patient beds (short stay facility)  Sept. 6 – 12, 1978 in Alma Ata, USSR
 manned by BHW (Barangay Health Worker) under
the supervision of a RHM (Rural Health Midwife “Alma Ata Declaration on PHC”
 Declarations:
Ratio (DOH 2009) RA 7305 (Magna Carta Public o Health is a basic fundamental right.
Healthcare Workers) o There exists global burden of health inequalities
 1 RHU: 20,000 Population among population.
 1 RH Physician/Nurse: 20,000 Population o Economic and social development is a basic
 1 RHM: 5,000 population importance for the full attainment of HFA.
 1 BHW: 20 households o Government have a responsibility for the health of
their people.
Category B: Custodial Facility
 a health facility that provides long-term care, including In the Philippines…
basic services like food and shelter to patients with  PHC was established through Letter of
chronic conditions requiring ongoing health and nursing Instruction (LOI) 949 signed on Oct. 19, 1979 by
care due to impairment or in need of rehabilitation then President Marcos one year after the First
 ex. Custodial psychiatric facilities, drug rehab centers, International Conference.
leprosaria, nursing homes Theme:
 “Health in the Hands of the People by 2020”
Category C: Diagnostic Facility
 a facility for the examination of the human body, Definition of Primary Health Care (Alma Ata
specimens from the human body for the diagnosis, Declaration)
 Drinking water analysis and treatment  PHC is essential health care based on practical,
Further classified into: scientifically sound and socially acceptable methods
a. Laboratory facility (Clinical lab, HIV testing, and technology made universally accessible to
Newborn Screening, Blood Services, individuals and families in the community through full
Drug Testing, water analysis) participation and at a cost that the community and
b. Radiologic facility (Xray, MRI, UTZ) country can afford to maintain at every stage of their
c. Nuclear medicine facility (application of development in the spirit of self-reliance and self-
radioactive materials for diagnosis, treatment and determination.
medical research
Goal of Primary Health Care
Category D: Specialized Outpatient Facility  "Health for All (HFA) by the year 2000"
 a facility that performs highly specialized procedures
on an outpatient basis Objectives of Primary Health Care
 Dialysis clinics  Promotion of healthy lifestyles
 Ambulatory surgical clinics  Prevention of diseases
 Cancer/Chemotherapeutic centers  Therapy for existing conditions
 Rehabilitation centers
5 Key Elements in Achieving HFA
1. Universal Coverage - reducing exclusion and social
disparities
2. Health Service Reforms - organizing health services
around people’s need
3. Public Policy Reforms – integrating health into all
sectors
4. Leadership Reforms – pursuing collaborative models
of policy dialogue
5. Increasing stakeholders’ participation

8 Essential Health Services (ELEMENTS)

-----
Key Principles of PHC
1. 4 A’s of health services
Affordability
 refers to the individual or family’s capacity to pay
for basic health services.
 also involves the capacity of the government or the
community can afford the basic health services
 (WHO) also considers the out-of-the-pocket
expenses for health care.
Accessibility
 refers to the physical distance of a health facility or
the travel time required for people to get the
needed or desired health services.
 (WHO) health care facilities should be within 30 6. Feasibility and Reliability
minutes from the community 7. Ecological effects
Acceptability 8. Potential to contribute to individual and
 means the health care offered is in consonance with community development
the prevailing culture and traditions of the
population. Strategies of PHC
Availability 1. Utilization of the 4As of Health Services
 is a question of whether the basic health services  Health services must be delivered where the people
required by the people are offered in the health care are
facilities or is provided on a regular and organized  Indigenous/ resident volunteer workers must be
manner. tapped as health care providers
 Use of traditional medicine must be used together
2. Support mechanism with essential drugs
 Health programs and projects have better outputs 2. Partnership between the community & health
when there is collaboration agencies
 A multi-sectoral approach is needed for an efficient  Establishment of an effective health referral system
utilization of resources.  Information, education and communication
support using multi media
3. Multi-sectoral approach  Collaboration between gov’t and NGO
 Health and diseases are outcomes of inter-related 3. Community Participation
factors, PHC requires 3C’s within and among  Small group meetings
various sectors  Community building & community organizing
3 C's:  Formation of health committees
 Communication 4. Self-Reliance
 Cooperation  community gives support (cash, kind or labor) to the
 Collaboration health program)
 Requires intra-sectoral and inter-sectoral linkages  use of local resources (human, financial or material)
 training of the community in leadership and
4. Community participation management skill
 An educational and empowering process in which 5. Recognition of inter-relationship between health &
people identify the problems, their needs and development
assume responsibilities to assess, plan, manage,  integration of the PHC into national, regional,
and control actions that are proven to be necessary. provincial, municipal & barangay development
 Clients are not recipient of care but active plans
participants  coordination of activities with economic planning,
education, agriculture, industry, housing, public
5. Equitable distribution of health resources works, communication & social services
 PHC advocates for care that is community-based 6. Social Mobilization
and preventive in orientation  Establishment of an effective health referral system
 There should be an inventory of health resources,  Information, education and communication support
facilities and manpower using multi media
 Collaboration between gov’t and NGO
6. Appropriate Technology 7. Decentralization
 Refers to the technology that is suitable to the  Re-allocation of budgetary resources
community that will use it and includes tools drugs,  Re-orientation of health professionals on PHC
methods, procedures and techniques  Advocacy for political will & support, from the
Criteria: national leadership down to the barangay level.
1. Safety
2. Effectiveness
3. Affordability
4. Simplicity
5. Acceptability

Levels of Prevention in Public Health

Levels of Prevention Objectives and Focus of Activities

1. Health Promotion
I. Primary Prevention
2. Specific Prevention
3. Early Diagnosis (Early detection)
II. Secondary Prevention
4. Prompt Treatment (Prompt Intervention)
III. Tertiary Prevention 5. Rehabilitation
I. Primary Prevention Strategic Instruments to Achieve the Strategic Thrusts
 Relates to activities directed at preventing a problem  Health Financing - Increased resources for health and
before it occurs by altering susceptibility or reducing proper allocation
exposure for susceptible individuals.  Service Delivery - Transform the health service
Focus of Activities: delivery structure
1. General health promotion  Policy, Standards and Regulations – ensure equitable
2. Specific protection
access to health services, essential medicines and
 The process of enabling people to increase control
technology
over, and to improve their health (Ottawa Charter of
Health Promotion, 1986)  Governance for Health
 Refers to behaviors in which one engages with  Human Resource for Health
the specific intent to prevent disease, to detect  Health Information – establish a modern information
disease in the early stages or to maximize health system
within the constraints of disease (Parse, 1990).
Universal Health Care Act
II. Secondary Prevention  Republic Act No. 11223
 Refers to early detection and prompt intervention  July 23, 2018 – February 20, 2019
during the period of early disease pathogenesis to  “An act instituting universal health care for all Filipinos,
prevent complications prescribing reforms in the health care system and
 Before signs and symptoms appear appropriating funds thereof.”
Focus of Activities:
1. Early diagnosis
2. Prompt treatment Objectives of the Law
 Progressively realize universal health care in the country
III. Tertiary Prevention (Rehabilitation) through systematic approach and clear delineation of
 Targets populations that have experienced disease roles of the key agencies and stakeholders towards
or injury and focuses on limitation of disability and better performance in the health system.
rehabilitation  Ensure that all Filipinos are guaranteed equitable
Aims: access to quality and affordable health care goods
1. Reduce the effects of disease and injury and services and protected against financial risk
2. Restore individuals to their optimal level of
functioning Key Features of the Law
 Financing
UNIVERSAL HEALTH CARE  Service Delivery
KALUSUGAN PANGKALAHATAN  Local Health System
Inequality – unequal access to opportunities  Regulation
Equality – evenly distributed tools and assistance  Governance and Accountability
Equity – custom tools that identify and address inequality
Justice – fixing the system to offer equal access to both FINANCING
tools and opportunities Membership
 Automatic inclusion if every Filipino into the National
Universal Health Care (Kalusugan Pangkalahatan) or Health Insurance Program (PhilHealth)
Aquino Health Agenda  Simplification of PhilHealth Membership
 A health reform program under Pres. Aquino (2010- (Direct/Indirect contributors)
2016) through A.O. 2010-0036 (DOH, 2010) Financing Source
 The “provision to every Filipino of the highest possible  Pooling of funds (Sin Tax, PAGCOR, PCSO, Gov’t and
quality of health care that is accessible, efficient, DOH)
equitably distributed, adequately funded, fairly  Population-based health services
financed, and appropriately used by an informed and  Individual-based health services
empowered public” Population-based Health Services
 It is an approach to health reform implementation  Refers to interventions, such as health promotion,
deliberately focused on economically disadvantage disease surveillance, and vector control, that address
Filipinos to ensure that they are given risk protection population-wide concerns.
(PhilHealth) and access to affordable and quality Individual-based Health Services
health services.  Refers to services that can be accessed within a health
facility or remotely, and can be definitively tracked back
Goals of Universal Health Care to one recipient.
 Better health outcome
 Sustained health financing SERVICE DELIVERY
 Responsive health system by ensuring that all Filipinos Delivery of Health Services
especially the disadvantage group have equitable access  DOH (PBHS)
to affordable health care (DOH, 2010)  Primary care provider
3 Strategic Thrusts of Universal Health Care  Epidemiologic Surveillance System
 Financial risk protection through expansion in NHIP  Health promotion programs
enrollment  PhilHealth (IBHS)
 Improved access to quality hospitals and health care Local Health System
facilities  Integration of health system into province-wide and
 Attainment of the health-related MDGs city-wide health system
 Pooling and management of all resources intended for During the last 30 years of Health Sector Reform, we
health “Special Health Fund” have undertaken key structural reforms and
REGULATION continuously built on programs that take us a step closer
 Establishment of performance-based incentive scheme to our aspiration.
for health facilities
 Licensing and regulatory system for stand-alone health MILESTONES:
facilities  Devolution
 Formulation of standards for clinical care (DOH,  Use of Generics
Professional Organization and academe)  Milk Code
 PhilHealth (1995)
GOVERNANCE AND ACCOUNTABILITY  DOH resources to promote local health system
 Submission of health-related data to PhilHealth as development
requirements for all public and private health related  Fiscal autonomy for government hospitals
entities Health Impact Assessment as requisite for  Good Governance Programs (ISO, IMC, PGS)
policies, programs and projects  Funding for UHC
 Health Information System as requisite for all health
service providers and insurers. PERSISTENT INEQUITIES IN HEALTH OUTCOMES
 Every year, around 2000 mothers die due to
pregnancy-related complications.
 a Filipino child born to the poorest family is 3 times
more likely to not reach his 5th birthday, compared
to one born to the richest family.
 3 out of 10 children are stunted.

RESTRICTIVE AND IMPOVERISHING

HEALTHCARE COSTS
 Every year, 1.5 million families are pushed to
poverty due to health care expenditures.
 Filipinos forego or delay care due to prohibitive and
unpredictable user fees or co-payments
 Php 4,000/month healthcare expenses considered
catastrophic for single income families

POOR QUALITY AND UNDIGNIFIED CARE

SYNONYMOUS WITH PUBLIC CLINICS AND
HOSPITALS
 Long wait times
 Limited autonomy to choose provider
 Less than hygienic restrooms, lacking amenities
 Privacy and confidentiality taken lightly
 Poor record-keeping
 Overcrowding & under-provision of care

AMBISYON NATIN 2040

 Investing in People
 Protection Against Instability
The Health System We Aspire For  Universal Health Coverage
GOALS:  Strengthen Implementation of RPRH Law
Financial Protection  War Against Drugs
 Filipinos, especially the poor, marginalized, and  Additional Funds From PAGCOR
vulnerable are protected from high cost of health care
Better Health Outcomes
 Filipinos attain the best possible health outcomes with
no disparity
Responsiveness
 Filipinos feel respected, valued, and empowered in all
of their interaction with the health system

VALUES:
 Equitable and Inclusive to All
 Transparent and Accountable
 Uses Resources Efficiently
 Provides High Quality Services
Guarantee #1 All Life Stages & Triple Burden of
Disease: Services for Both the Well & the Sick

Guarantee #2 Service Delivery Network: Functional

Network of Health Facilities
Services are delivered by networks that are
 Fully Functional – complete equipment,
medicines, health professional
 Compliant with Clinical Practice Guidelines
 Available 24/7 & Even During Disasters
 Practicing Gatekeeping
 Located Close To The People – mobile clinic or
subsidize transportation cost
 Enhanced by Telemedicine

Guarantee #3 Universal Health Insurance: Financial

Freedom when Accessing Services

Strategy
A Advance health promotion, primary care and quality
C Cover all Filipinos against financial health risk
H Harness the power of strategic HRH
I Invest in eHealth and data for decision-making
E Enforce standards, accountability and transparency
V Value clients and patients
E Elicit multi-stakeholder support for health