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PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH CARE  Mobilization of the people

SERVICE
 with the end view of providing appropriate solutions leading to
self-reliance and self determination

PRIMARY HEALTH CARE  Development and utilization of appropriate technology

 Essential health care made universally accessible to individuals and families  focusing on local indigenous resources available in and
in the community by means of acceptable to them through their full acceptable to the community
participation and at a cost that the community and country can afford at
every stage of development  Organization of communities arising from their expressed needs

 Primary health care was declared during the First International Conference
 Increase opportunities for community participation
on PHC held in Alma Ata USSR on September 6 – 12, 1978 by WHO with a
goal of “Health for All by the year 2000”
 Development of intra-sectoral linkages with other government and private
agencies
 Primary Health Care was adopted in the Philippines through LOI 949 signed
by Pres. Marcos on October 19, 1979 and has an underlying theme of
 Emphasizing partnership
“Health in the hands of the People by 2020”

Framework for meeting the goal of PHC


Concept of PHC is characterized by;

 Partnership and empowerment of the people


 Organizational strategy

o calls for active and continuing partnership among the


 PHC is a strategy
communities, private and government agencies in health
development
 which focuses responsibility for health on the
individual, his family and the community

 PHC includes full participation and active involvement of the Four cornerstones/Pillars in PHC
community
1. Active community participation

 towards the development of self-reliant people,


2. Intra and Inter-sectoral linkages
capable of achieving an acceptable level of health
and well being
3. Use of appropriate technology

 PHC recognizes the interrelationship between health and the 4. Support mechanisms made available
overall political, socio-cultural and economic development of
society Two levels of PHC workers

1. Village or Barangay Health Workers

Elements/Components of PHC 2. Intermediate Level Health Workers

1. Environmental Sanitation a. General medical practitioners

2. Control of communicable diseases b. PHN

3. Immunization c. RSI

4. Health Education d. RHM

5. Maternal and Child Health and Family Planning LEVELS OF HEALTH CARE AND REFERRAL SYSTEM

6. Adequate Food and Proper Nutrition  Primary Level of Care

7. Provision of Medical Care and Emergency Treatment o Devolved to the cities and municipalities

8. Treatment of Locally Endemic Diseases o Health care provided by the center physicians, PHN, RHM,
BHW, TBAs and others
9. Provision of Essential Drugs
o Usually the first point of contact between the community
Strategies members and other levels of health facility

 Reorientation and reorganization of the national health care system (RA  Secondary Level of Care
7160)
o Given by physicians with basic health training
 Effective preparation and enabling process for health action at all levels
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o Usually given in health facilities either privately owned or Basic unit of the community
government operated such as infirmaries, municipal and district
hospitals, out-patient departments of provincial hospitals Concerned with the health of the mother, unborn, newborn, infant, child,
adolescent and youth, adult men and women and older persons
o Serves as a referral center for the primary health facilities
Aims to:
o Capable of performing minor surgeries and perform some
simple laboratory examinations 1. Improve the survival, health and well being of mothers and the
unborn
 Tertiary Level of Care
a. Pre-pregnancy
o Rendered by specialists in health facilities including medical
centers as well as regional and provincial hospitals and b. Prenatal
specialized hospitals
c. Natal
o Referral center for the secondary care facilities
d. Postnatal stages
LEVELS OF HEALTH CARE SERVICES
2. Reduce morbidity and mortality rates:
 Tertiary level care facilities
a. Children 0-9 years old
o National and Regional Health Services
b. Among Filipino adults and older persons and improve
quality life
o Medical centers

c. Mortality from preventable causes among adolescents


o Teaching and Training hospitals
and young people

 Secondary level care facilities

o Provincial / City health services and hospitals A. MATERNAL HEALTH PROGRAM

o Emergency and District hospitals Tasked to reduce MMR by three quarters by 2015 to achieve MDG

 Primary level care facilities


Maternal Mortality Rate (2003)
o RHU CAUSE
1. Other Complications related to pregnancy occurring in the course of
labor, delivery and puerperium
o Community hospitals & health centers 2. Hypertension complicating pregnancy, childbirth and puerperium
(25%)
o Private practitioners, puericulture centers 3. Postpartum hemorrhage (20.3%)
4. Pregnancy with abortive outcome (9%)
5. Hemorrhage related to pregnancy
o BHS
Strategic thrusts for 2005-2010
PUBLIC HEALTH PROGRAMS 1. Launch and implement Basic Emergency and Obstetric Care
(BEMOC) strategy in coordination with DOH
a. Entails establishment of facilities that provide emergency
Sets of interventions put together to operationalize policies and standards obstetric care for every 125,000 population and which are
directed towards the prevention of certain public health problems located strategically
2. Improve quality of prenatal and postnatal care
I. Family Health a. Pregnant women should have at least four (4) prenatal
visits
3. Reduce women’s exposure to health risks
II. Non-communicable Disease Prevention and Control
a. Institutionalization of responsible parenthood
4. Stakeholders must advocate for health
III. Communicable Disease Prevention and Control a. Resource generation and allocation for health services

IV. Environmental Health and Sanitation Essential Health Service Packages

A. Antenatal Registration
V. Other priority health programs
Prenatal visits Period of pregnancy
a. Sentrong Sigla 1st visit As early in pregnancy as possible before four months or
during the first trimester
b. Herbal Medicine 2nd visit During the 2nd trimester
3rd visit During the 3rd trimester
Every two weeks After 8th month of pregnancy till delivery
c. Health Emergency Preparedness and Response Program
B. Tetanus Toxoid Immunization
d. National Voluntary Blood Services Program C. Micronutrient Supplementation

e. Botika ng Barangay Vitamins Dose Schedule Remarks


Vitamin A 10,000 IU 2x a week Do not give Vitamin A
starting on the before 4th month of
4th month of pregnancy. It might cause
pregnancy congenital problems in the
FAMILY HEALTH baby

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Iron 60mg/400 ug Daily
tablet Strategic thrusts for 2005-2010
1. Pursuing the sentrong sigla initiative
Recommended Schedule for Post Partum Care Visits 2. Apply REB strategy for immunization
3. Intensify health education and information campaign
1st visit 1st week post partum preferably 3-5 days 4. IMCI and BEMOC strategy
2nd visit 6 weeks post partum 5. Implementation of laws and policies for the protection of newborns
a. Early Childhood Development Act of 2000
b. Newborn Screening Act of 2004
B. FAMILY PLANNING PROGRAM c. EO 286, Bright Child Program
Annual Population Growth d. EO 51, Milk Code
2.36% e. Rooming-in and Breastfeeding Act
Population expected to double in 29 years
Total fertility rate Infant and Young Child Feeding (IYCF)
3.5 children/woman Global Strategy for IYCF issued jointly by the WHO and UNICEF in 2002 as
3 to 4 million getting pregnant/year endorsed by the World Health Assembly in May 2002 and the UNICEF Executive
85% expected to progress full term Board in September 2002

National Demographic and Health Survey (2003) Strategy calls for the:
44% women got pregnant with 1st child ages 20-24 1. Promotion of breastmilk as the ideal food for the healthy growth and
6.1% Ages 15-19 development of infants
35-39 – highest percentage of using contraceptives 2. Exclusive breastfeeding for the first 6 months of life
15-19 – lowest percentage
Overall objective:
Married women Improve the survival of infants and young children by improving their nutritional
48.8% - use any form of contraceptive method status, G & D through optimal feeding
33.4% - modern method
15.5% - traditional method National Plan of Action for 2005 – 2010 for IYCF
51.1% - do not use any form of contraceptive method GOAL
Reduce Child Mortality Rate by 2/3 by 2015
Family Planning Methods OBJECTIVE
1. Female sterilization Improve health and nutrition status of infants and young children
a. Cutting or blocking two fallopian tubes (BTL) OUTCOME
b. 99.5% of effectiveness Improve exclusive and extended breast feeding and complementary feeding
2. Male sterilization
a. Vas deferens is tied and cut or blocked through a small Specific Objectives
opening on the scrotal skin (Vasectomy) 1. 70% of newborns are initiated to breastfeeding within one hour after
b. Effective 3 months after the procedure birth
c. 98.9% to 99.9% effective 2. 60% of infants are exclusively breastfed up to 6 months
3. Pill 3. 90% of infants are started on complementary feeding by 6 months of
a. Hormones – estrogen and progesterone age
b. Taken daily PO 4. Median duration of breastfeeding is 18 months
c. 92.0% to 99.7% effective
4. Male condom
a. Thin sheath of latex Key messages on IYCF
b. Dual protection from STIs including HIV 1. Initiate breastfeeding within 1 hour after birth
c. 85% to 98% effective 2. Exclusive for the first 6 months of life
5. Injectables 3. Complemented at 6 months, excluding milk supplements
a. Synthetic hormone – progestin which suppresses 4. Extend breastfeeding up to 2 years and beyond
ovulation, thickens cervical mucus
b. 97.0% to 99.7% effective
6. LAM National IYCF strategy
a. Postpartum method of postponing pregnancy based on 1. Health Facilities
physiological infertility experienced by breast feeding a. Mother-baby friendly hospitals
women b. Health workers
b. Effective only for a maximum of 6 months postpartum i. Advocates
c. 99.5% to 98% effective ii. Protectors
7. Mucus/Billings/Ovulation iii. Promoters of IYCF
a. Abstaining from SI during fertile days iv. Enforcers of laws, not violators
b. Can not be used by woman with unusual disease or 2. Family/Community
condition that results in extraordinary vaginal discharge a. Supportive family
that makes observation difficult b. Milk Code “vigilantes”
c. 80% to 97% effective c. Lay/Peer counselors
8. BBT d. IYCF “bayanihan” spirit
a. Identifying the fertile and infertile period by daily taking e. Mother-baby friendly public places
and recording rise in BT during and after ovulation 3. Working places
b. Temp is taken 3 hours of undisturbed rest (usually a. Maternity leave
morning) b. Lactation/Breastfeeding room
c. 80% to 99% effective c. Breastfeeding breaks
9. Sympto-thermal method 4. Industry
a. Combination of BBT and Billing/Mucus method a. Comply with the “Code”
b. 9% to 80% effective 5. Schools
10. Two day method a. Introducing the “breastfeeding culture”
a. Simple fertility awareness based method
i. Cervical secretions as an indicator of fertility
ii. Checking the presence of secretions daily Laws that protects IYCF
b. 86% to 96.5% effective 1. EO 51, Milk Code
11. Standard days method 2. Rooming-in and Breastfeeding Act of 1992
a. Users with menstrual cycle between 26 and 32 days are 3. RA 8976, Food Fortification Law of 2000
counseled to abstain from SI on days 8-19 to avoid
pregnancy
b. 88% to 95% effective D. EXPANDED PROGRAM IMMUNIZATION

C. CHILD HEALTH PROGRAMS General principles which apply in vaccinating children


Main goal is to reduce morbidity and mortality rates for children 0-9 years old

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1. Safe and immunologically effective to administer all EPI vaccine on • Must be professionally qualified and licensed to practice in the arena
the same day at different sites of the body of public health nursing
2. Measles vaccine should be given as soon as the child is 9 months old
a. 9 months – 85% protection
• Consistent with the nursing law of 2002 (RA 9173)
b. 1 year above – 95% protection
3. Vaccination schedule should not be restarted from the beginning
even if the interval between doses exceeded the recommended Management function
interval by months or years
4. Moderate fever, malnutrition, mild respiratory infection, cough, – Inherent in the practice of PHN
diarrhea and vomiting are not contraindicated to vaccination; unless
the child is so sick that he needs to be hospitalized
5. Absolute contraindications to immunizations are: – Organizes the nursing service of the local health agency
a. DPT2 or DPT3 to a child who has had convulsions or
shock within 3 days the previous dose Supervisory function
b. Vaccines containing the whole pertussis component
should not be given to children with an evolving
– Supervisor of the midwives and other health workers
neurological disease
c. Live vaccines like BCG must not be given to
immunosuppressed due to malignant disease (child with Nursing care function
clinical disease), therapy with immunosuppressive agents
or irradiation – Inherent function of the nurse
6. Safe and effective with mild side effects after vaccination. Local
reaction, fever and systemic symptoms can result as part of the
normal immune response – Based on the science of art and caring
7. Giving doses of vaccine at less than the recommended 4 weeks
interval may lessen the antibody response. Lengthening the interval – Caring for all levels of clientele toward health promotion
between doses of vaccines leads to higher antibody levels and disease prevention
8. No extra doses must be given to children who missed a dose of
DPT/HB/OPV/TT
9. Strictly follow the principle of never, ever reconstituting the freeze Collaborating and coordinating function
dried vaccines in anything other than the diluents supplied with them
10. Repeat BCG vaccination if the child does not develop a scar after the – Care coordinators for communities and their members
1st injection
11. Use one syringe one needle per child during vaccination – Establishes linkages and collaborative relationships with
other health professionals, government agencies, private
Routine Immunization Schedule for Infants sectors, NGO’s people’s organizations to address health
A child is said to be “Fully Immunized Child” (FIC) when a child receives 1 dose problems
of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and 1 dose of measles
before a child’s 1st birthday
Health promotion and education function
Vaccine Minimum age at 1st Number of Minimum interval between
dose doses doses – Activities goes beyond health teachings and health
BCG Birth or anytime 1 None information campaigns
after birth
DPT 6 weeks 3 4 weeks
Training function
OPV 6 weeks 3 4 weeks
Hep B At birth 3 6 weeks interval 1st to 2nd
dose; 8 weeks from 2nd to – Initiates the formulation of staff development and training
3rd dose programs for midwives and other auxiliary workers
Measles 9 months 1 None
Research function
Tetanus Toxoid Immunization Schedule for Women
Vaccine Minimum % protected Duration of protection
– Participates in the conduct of research and utilizes
age/interval
research findings in her practice
TT1 Early during
pregnancy
TT2 4 weeks later 80% 3 yrs for the mother • Disease surveillance
TT3 6 months later 95% 5 yrs for the mother
TT4 1 year later 99% 10 yrs for the mother – Measure the magnitude of the
TT5 1 year later 99% Lifetime for the mother; problem
All infants born will be
protected
– Measure the effect of the control
EPI vaccines and characteristics program
Vaccine Storage Temp
Most sensitive to Oral Polio (live -15C to -25C (at the freezer) • NURSING PROCEDURES
heat attenuated)
Measles (freeze dried) -15C to -25C (at the freezer)  Clinic visit
Least sensitive to DPT/Hep B +2C to +8C (in the body of
heat “D” toxoid; wekened toxin the refrigerator)
“P” killed bacteria  Patient visits the health center
“T” weakened toxin
Hep B +2C to +8C (in the body of Most common is BP measurement
the refrigerator)
BCG (freeze dried) +2C to +8C (in the body of
Tetanus Toxoid the refrigerator)  Home visit

 Family-nurse contact
THE PUBLIC HEALTH NURSE

 The PHN visits the patient


• Qualifications and Functions

 Bag technique

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 Tool by which the nurse during her visit will enable her to • In order to identify the different factors that
perform a nursing procedure with ease and deftness, may directly or indirectly influence the health
save time and effort of the population

 Most important principle – Analyzing & interpreting health data

Minimize if not prevent the spread of any • Seek explanations for the occurrence of
infection health needs and problems of the community

 Important points to consider in the use of the bag – Formulation of Community Health Nursing Diagnoses

Contain all necessary articles • Will become the bases for developing and
implementing community health nursing
interventions and strategies
Cleaned very often

• Types of Community Diagnosis


Well protected

• Comprehensive community diagnosis


Arrangement-most convenient
– Aims to obtain general information about the community
Assessing Community Health Needs
• Problem Oriented community diagnosis
• COMMUNITY HEALTH NURSING
– Responds to a particular need
• COMMUNITY
• ELEMENTS OF
– Primary client
COMPREHENSIVE COMMUNITY DIAGNOSIS

• HEALTH
1. DEMOGRAPHIC VARIABLES

– Goal
– Total population & Geographical distribution including
Urban-Rural index & Population Density
• NURSING
– Age & Sex composition
– Means
– Selected vital indicators e.q. Growth rate, CBR, CDR &
• COMMUNITY Life expectancy rate

• Group of people sharing common geographic boundaries, common – Patterns of migration


values and interest
– Population projection
• Functions within a particular socio-cultural context, which means that
no two communities are alike
• Note:

• Primary client of CHN


– Population groups that need special attentions:

– Has a direct influence on the health of the individual,


• Indigenous people
families and sub-populations
• Internal refugees
– It is at this level that most health service provision occurs
• Socially dislocated groups as a result of
• Regarded as an organism with its own stages of development
disasters, calamities & development programs

– Matures through time


– Socio-economic & Cultural variables

• COMMUNITY DIAGNOSIS
– Social indicators

• Done to come up with a profile of local health situation • Communication network

– Will serve as a basis of health programs and services to • Transportation system


be delivered to the community
• Educational level

• Starts with determining the health status of the community


• Housing conditions

• PROCESS OF COMMUNITY DIAGNOSIS – Economic indicators

• Consists of; • Poverty level income

– Collecting, organizing & synthesizing data • Employment rate

• Types of industry present in the community

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• Occupation common in the community  Health Related Problems

– Environmental indicators Existence of social, economic, environmental and political


factors that aggravate the illness-inducing situations in the
• Physical/geographical/topographical community
characteristics
• Priority-setting
• Water supply
• Nature of the condition/problem presented
• Waste disposal
– Classified as health status, health resources or health
• Air, Water and Land pollution related problems

– Cultural factors • Magnitude of the problem

• Variables that may break up people into – Severity of the problem which can be measured in terms
groups within the community e.q. of the proportion of the population affected by the problem

– Ethnicity • Modifiability of the problem

– Social class – Probability of reducing, controlling or eradicating the


problem
– Language
• Preventive potential
– Religion
– Probability of controlling or reducing the effects posed by
– Race the problem

– Political orientation • Social concern

• Cultural beliefs and practices that affect – Perception of the population or the community as they are
health affected by the problem and their readiness to act on the
problem
• Concepts about Health and Illness
• Application of Public Health Tools
3. Health & illness patterns

– Leading cause of mortality

– Leading cause of morbidity

– Leading cause of infant mortality


Community Health Nursing
– Leading cause of maternal mortality
• Three important tools
– Leading cause of hospital admission
The health disciplines of
4. Health resources
• Demography
– Manpower resources
• Vital statistics
– Material resources
• Epidemiology
5. Political/Leadership patterns
• DEMOGRAPHY
– Reflects the action potential of the state and its people to
address the health needs and problems of the community • Science which deals with the study of the human population’s

– Mirrors the sensitivity of the government to the people’s – Size


struggle for better lives
– Composition
• Identifying Community Health Nursing Problems
– Distribution in space
 Health Status Problems
• SOURCES OF DEMOGRAPHIC DATA
Increased/decreased morbidity, mortality fertility or
reduced capability for wellness Can be obtained from a variety of sources

 Health Resources Problems • Censuses

Lack of or absence of manpower, money, materials or • Sample surveys


institutions necessary to solve health problems
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• Registration systems • Abs. Increase/year = Pt – Po

• Two ways of assigning people when the census is being taken t

De jure • where:

• Done when people are assigned to the place where they usually live – Pt = pop. Size at a later time
regardless of where they are at the time of the census
– Po = pop. Size at an earlier time
De facto
– t = no. of years between 0 and time t.
• People are assigned to the place where they are physically present at
the time of the census regardless of their usual place or residence • Method 2

• POPULATION SIZE RELATIVE INCREASE

• Refers to the number of people in a given place or area at a given • Actual difference between the two census counts expressed in
time percent relative to the population size made during an earlier census

• Allows the nurse to make comparisons about population changes • Relative increase = Pt – Po
over time
Po
• Helps rationalize the types of health programs or interventions which
are going to be provided for the community • Where:

• Estimated Population – Pt = population size at a later time


Percentage Distribution, By Age and Sex
Philippines, 2005 – Po = population size at an earlier time

• TWO METHODS IN • POPULATION COMPOSITION


DETERMINING POPULATION SIZE
Pertaining to population size’s variables such as:
Method 1
• Age
• Determining the increase in the population resulting from excess of
births compared to deaths • Sex

Method 2 • Occupation

• Determine the increase in the population using data obtained during • Educational level
two census periods. This implies that the increase in the size of the
population is not merely attributed to excess in births but also the
• Commonly described in terms of its age and sex
effect of migration

• Nurse utilizes data on age and sex composition to decide who among
• Method 1
the population groups merits attention in terms of health services and
programs
NATURAL INCREASE
• SEX COMPOSITION
• Difference between the number of births and the number of deaths
occurring in a population in a specified period of time
• To describe the sex composition of the population, the nurse
computes for the
Nat. increase = no. births – no. of deaths
“sex ratio”
Specified year
• Sex ratio compares the no. of females in the population
• Method 1
Sex ratio = Number of males
RATE OF NATURAL INCREASE
Number of females
• Difference between the CBR and the CDR occurring in a population
in a specified period of time
• The sex ratio represents the number of males for every 100 females
in the population
Rate of Nat. increase = CBR – CDR

• AGE COMPOSITION
Specified year

• Two ways to describe the age composition of the population


• Method 2

MEDIAN AGE
ABSOLUTE INCREASE PER YEAR

• Divides the population into two equal parts.


• Measures the number of people that are added to the population per
year.
DEPENDENCY RATIO

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• Compares the number of economically dependent with the • MORBIDITY (2002)
economically productive group in the population.
• MORTALITY
• Economically dependent
• Ten Leading Causes of Mortality by Sex
– 0 – 14 Number, Rate/100,000 Population & Percentage
Philippines, 2002
– 65 and above
• MORTALITY
• Economically productive

– Within 15 – 64 age group


EPIDEMIOLOGY
• POPULATION DISTRIBUTION
• Study of the occurrence and distribution of health conditions such as
• The measures help the nurse decide how meager resources can be disease, deformities or disabilities on human populations
justifiably allocated based on concentration of population in a certain
place • Two main areas of concern

1. Urban-Rural distribution – Study of occurrences and distribution of diseases

2. Crowding Index – Search for the determinants (causes) of the disease and
its observed distributions
3. Population Density
• Backbone of the prevention of diseases
• VITAL STATISTICS
• EPIDEMIOLOGY
• VITAL STATISTICS
Epidemiology
• Refers to the systematic study of vital events such as births,
illnesses, marriages, divorces/separations and deaths rests on two important concepts;

• Tool in estimating the extent or magnitude of health needs and • Multiple Causation Theory
problems in the community
• Levels of Prevention of Health Problems
• Common health indicators
• Multiple Causation Theory
• Fertility rates
• Disease development does not rest on a single cause
– Crude birth rate (CBR)
• Health conditions result from a multitude of factors
– General fertility rate (GFR)
• Model that explain the MCT
• Mortality rates
– Ecologic Triad/Epidemiologic triangle
– Crude death rate (CDR)
• AGENT
– Specific mortality rate (SMR)
• Any element, substance or force, either animate or inanimate. The
– Cause of death rate presence or absence of which may serve as stimulus to initiate or
perpetuate a disease process
– Infant mortality rate (IMR)
– Disease process happens only when the agent comes in
– Maternal mortality rate (MMR) contact with a susceptible host and under proper
environmental conditions
– Proportionate mortality rate (PMR)
– Intrinsic property of microorganism to survive and multiply
– Swaroops index in the environment to produce disease

– Case fatality rate (CFR) • HOST

• Morbidity rate • Any organism that harbors and provides nourishment for another
organism
– Incidence rate
• Characteristics of the host will affect his or its risk of exposure to
– Prevalence rate sources of infection and his or its susceptibility or resistance

• MORBIDITY • HOST

• TEN LEADING CAUSES OF MORBIDITY • Intrinsic factors of the host


No. & Rate/100,000 Population
PHILIPPINES, 2002 – Genetic

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– Age • May be in the form of level of economic
development of the community, presence of
– Sex social disruptions

– Ethnic group • LEVELS OF PREVENTION OF HEALTH PROBLEM

– Physiologic • Promoting health and Preventing health problems

– Immunologic experience (immunization) • Make up most of the nurse’s activities in the community

– Inter-current or pre-existing disease • PREVENTION

– Human behavior • Refers to identification of potential problems;

• RESISTANCE • so that the nurse can minimize or probably even eradicate possible
disability or deformity in a population-at-risk to a negative exposure
• Specific factor

– Results from an immunologic experience such as; • PRIMARY PREVENTION


immunization or vaccination
• Directed to the healthy population
• Non-specific
– Primordial prevention
– Results from an intact skin, mucous membrane, reflexes
as lacrimation, coughing, diarrhea or vomiting • Focusing on prevention of emergence of risk
factors
– Can be maintained through personal hygienic practices,
environmental sanitation, proper nutrition and a healthy – Specific protection
lifestyle
• Removal of the risk factors or reduction of
• COMMUNITY their levels

• Community as a host • PRIMARY PREVENTION

– Protects its health by the nurse by increasing its herd • In Communicable disease prevention
immunity
– Activities on primary prevention are targeted at
• Herd Immunity intervening before the agent enters the host and cause
pathological changes
– Probability of a group or community developing an
epidemic introduction of an infectious agent – It aims to;

– It is the proportion of the immunes and the susceptible in • strengthen the host resistance
the group
• Inactivate the agent (source of infection)
• ENVIRONMENT
• Interrupt the chain of infection through
• Sum total of all external conditions and influences that affect the life environmental manipulation
and development of an organism
• Prevention of spread to human reservoirs and
• Affects the agent and the host other susceptible human hosts

• ENVIRONMENT • PRIMARY PREVENTION

• Three components of environment • Primary prevention can be done through;

– Physical environment – Personal surveillance

• Composed of the inanimate surroundings e.q. – Quarantine


geophysical conditions or the climate
– Segregation or isolation
– Biological environment
• Health promotion activities include;
• Makes up the living things around us e.q.
plant and animal life – Provision of proper nutrition

• Human population – Safe water supply and waste disposal system

– Socio-economic environment – Vector control

– Promotion of a healthy lifestyle

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– Good personal habits • Answers questions about the effectiveness of new
methods for controlling diseases or for improving
• Specific measures include provision of; underlying conditions

– Immunization 4. Evaluation epidemiology

– Prophylaxis to vulnerable or at-risk groups • Attempts to measure the effectiveness of different health
services and programs
• SECONDARY PREVENTION
• DESCRIPTIVE EPIDEMIOLOGY
• Aims to identify and treat existing health problems at the earliest
possible time Aspects involved in descriptive epidemiology

• Interventions can still lead to the control or eradication of the health 1. Observation and recording of existing patterns of occurrence of the
problem health condition under study

– Screening 2. Description of the disease/condition as to person, place and time


characteristics
– Case finding
3. Analysis of the general pattern of occurrence of the disease or
– Disease surveillance condition

– Prompt and appropriate treatment • ASPECT 1

• SECONDARY PREVENTION I. Observation and recording of existing patterns of occurrence of the


health condition under study
• In Communicable disease control;
 In order to describe the occurrence of disease condition;
– Health education on signs and symptoms will enable the the nurse needs to recognize or identify the disease with
client to identify illness and seek early care or treatment reasonable certainty

• Done by conducting
– Knowledge of risk behaviors that contribute to the spread
of the disease may influence patients and the families to
– Screening
modify this behavior and, thus, assist in the prevention of
disease
– Case finding activities

• TERTIARY PREVENTION
• ASPECT 1

• Limits disability progression


• SCREENING

– The nurse attempts to reduce the magnitude or severity of


– Presumptive identification of unrecognized diseases or
the residual effects of;
defects through the application of diagnostic tests or
laboratory examinations and clinical assessment
• Infectious diseases
• CASE FINDING
– E.q hearing impairment from
frequent ear infections
– Done to look for previously unidentified cases of diseases

• Non-communicable diseases
• Screening & Case Finding

– Mental illness, CVD


– Should consider the sensitivity and specificity of the tests

– Day care centers and sheltered workshops are examples


• ASPECT 1
of opportunities to achieve the objective of tertiary
prevention in mental illness and drug abuse
• SENSITIVITY

• THE EPIDEMIOLOGICAL APPROACH


– Proportion of persons with a disease who test positive on
a screening test
• PHASES

– Measures the probability of the test correctly identifying a


1. Descriptive epidemiology
positive case of a disease

• Concerned with disease distribution and frequency


• SPECIFICITY

2. Analytical epidemiology
– Proportion of a persons without a disease who have
negative results on a screening test
• Attempts to analyze the causes or determinants of
disease through hypothesis testing
– Measures the probability of correctly identifying non-
cases
3. Intervention or Experimental epidemiology
• ATTACK RATE
10
– Used to calculate an identifiable population exposed to an
– Represents opportunities for progressive opportunities for
infectious agent
progressive transfer or transmission of an infectious agent
to a susceptible host and depends on the;
– Represents the incidence of the illness among the
exposed population
• Frequency of contact

– Frequently used in surveillance and control of


• Facility of transmission
communicable diseases

3. CHANCE
– ASPECT 2

– Probability of contact between the


II. Description of the disease/condition as to person, place and time
characteristics
• Source of infection

– After the disease or condition has been identified with


• Susceptible host
reasonable certainty; the number of persons who possess
the disease are recorded noting down the;
– Depends upon the
• Characteristics of the afflicted persons
• Number of sources of infection
• Time the disease was initially recognized
• Number of immunes
• Characteristics of the place where the cases
came from • Location of the source of infection

– To a certain extent;

• Nurse can derive associations between Disease occurrence can be described by the following:

– Risk of acquiring a disease A) Short time fluctuations common in epidemics

– Characteristics of persons – Common source epidemic – characterized by


simultaneous exposure of a large number of susceptible
to a common infectious agent
• ASPECT 2

– Propagated epidemic – caused by a person-to-person


• Some variables provide clues as to the probable cause of the
transmission of disease agent
disease;

B) Cyclic variation – refers to recurrent fluctuations of disease that may


– Age
exhibit cycles lasting for certain periods

– Sex
C) Secular variation – refers to changes in disease frequency over a
period of many years
– Marital conditions

• ASPECT 3
– Occupation or socio-economic status

3. Analysis of the general pattern of occurrence of the disease or


• In viewing the susceptibility of the community as a host;
condition

– The nurse determines the characteristics of the


– Establishing the
community and its population in terms of the following;

• Disease frequency
• Herd immunity

• Disease distribution in a population


• Exposure or Contact Rate

– Defining the characteristics of the disease or condition in


• Chance
relation to

• ASPECT 2
• Time

1. Herd Immunity
• Place

– Basis for determining the community’s reaction against • Person


disease invasion since it represents the immunity and
susceptibility levels of individuals comprising the – Correlating the data and formulate a causal association
population between the

– The immunity level is inversely proportional to • Disease under study


susceptibility level
• Probable factors surrounding it
2. EXPOSURE or CONTACT RATE
DISEASE DISTRIBUTION

11
• Variables affecting disease distribution a. Intrinsic property of microorganism to survives and
multiply in the environment to produce disease
– Time
2. Host
• Period during which the cases of the disease
being studied were exposed to the source of a. Any organism that harbors and provides nourishment for
infection and the period during which the another organism
illness occurred
3. Environment
– Persons
a. Sum total of all external conditions and influences that
• Characteristics of the individual who were affects the development of an organism, can be
exposed and who contacted the infection or biological, social and physical
the disease
b. Affects both the agent and the host
– Place
c. Three components of environment
• Features, factor or conditions which existed in
or described the environment in which the i. Physical
disease occurred
ii. Biological
Patterns of occurrence and distribution
iii. Socio-economic environment
• Sporadic
Intrinsic factors of the host
– Intermittent occurrence (rabies)
1. Genetic
• Endemic occurrence
2. Age
– Continuous occurrence throughout a period of time
3. Sex
• Malaria – Palawan
4. Ethnic group
• Schistosomiasis – Leyte and Samar
5. Physiologic
• Filariasis – Sorsogon
6. Immunologic experience (immunization)
• Tuberculosis – all specific areas of the country
7. Inter-current or pre-existing disease
• Epidemic occurrence
8. Human behavior
– Unusually large number of cases in a relatively short
period of time Extrinsic factors of the environment

• Pandemic occurrence 1. Physical environment

– Simultaneous occurrence of epidemic of the same 2. Biologic environment


disease in several countries
a. Human population

b. Flora
EPIDEMIOLOGY
3. Socio-economic

a. Occupation
Two main areas of concern
b. Urbanization
- Study of occurrences and distribution of diseases
c. Disruption
- Search for the determinants (causes) of the disease and its observed
distributions

Backbone of the prevention of diseases DISEASE DISTRIBUTION

Variables affecting disease distribution

Epidemiologic triangle 1. Time

1. Agent

12
a. Period during which the cases of the disease being b. General fertility rate (GFR)
studied were exposed to the source of infection and the
period during which the illness occurred 2. Mortality rates

2. Persons a. Crude death rate (CDR)

a. Characteristics of the individual who were exposed and b. Specific mortality rate (SMR)
who contacted the infection or the disease
c. Cause of death rate
3. Place
d. Infant mortality rate (IMR)
a. Features, factor or conditions which existed in or
described the environment in which the disease occurred e. Maternal mortality rate (MMR)

f. Proportionate mortality rate (PMR)

Patterns of occurrence and distribution g. Swaroops index

1. Sporadic h. Case fatality rate (CFR)

a. Intermittent occurrence (rabies) 3. Morbidity rate

2. Endemic occurrence a. Incidence rate

a. Continuous occurrence throughout a period of time b. Prevalence rate

i. Malaria – Palawan

ii. Schistosomiasis – Leyte and Samar COMMUNITY ORGANIZING

iii. Filariasis – Sorsogon

iv. Tuberculosis – all specific areas of the country Empowerment or building the capability of people for future community action

3. Epidemic occurrence

a. Unusually large number of cases in a relatively short Five stages


period of time
1. Community analysis
4. Pandemic occurrence
a. Maybe referred to as community diagnosis, community
a. Simultaneous occurrence of epidemic of the same needs assessment, health education planning and
disease in several countries mapping

b. Steps in community analysis

VITAL STATISTICS i. Defining the community

- Refers to the systematic study of vital events such as births, illnesses, 1. Determining the geographic
marriages, divorce, separation and deaths boundaries of the target
community
- Statistics of disease (morbidity) and death (mortality) indicate the state of health
of a community and the success or failure of health work ii. Collecting data

iii. Assessing community capacity

Sources of data 1. Entails an evaluation of the driving


forces which may facilitate or
1. Population census impede the advocated change

2. Registration of vital data iv. Assessing community barriers

3. Health survey v. Assessing readiness to change

4. Studies and researches 1. Community interest

Common health indicators 2. Perception on the importance of


the problem
1. Fertility rates
vi. Synthesis data and set priorities
a. Crude birth rate (CBR)

13
1. Basis for designing prospective Nursing process is a systematic, scientific, dynamic, on-going interpersonal
community interventions for health process in which the nurses and the clients are viewed as a system with each
promotion affecting the other and both being affected by the factors within the behavior

2. Design and initiation

a. Establishing a core planning group and select a local 1. Assessment


organizer
a. Collecting data
b. Choosing organizational structure
b. Categorizing health problems
c. Recruit organizational members
i. Health deficit
d. Defining mission and goals
1. Gap between actual and
e. Provide training and recognition achievable health status

3. Implementation ii. Health threat

4. Program maintenance – consolidation 1. Conditions that promote disease


or injury and prevent people from
5. Dissemination – reassessment realizing their health potential

iii. Foreseeable crisis

1. Stressful occurrences such as


NURSING PROCEDURES death or illnesses of a family
member

c. Process of assessment includes


I. Clinic visit
i. Intensive fact finding
a. Patient visits the health center
ii. Application of professional judgment in
i. Most common is BP measurement estimating the meaning and importance of
facts to the family and community
II. Home visit
iii. Availability of nursing resources that can be
a. Family-nurse contact provided

b. The PHN visits the patient iv. Degree of change which nursing intervention
can be expected to effect
III. Bag technique
2. Planning nursing actions/care
a. Tool by which the nurse during her visit will enable her to
perform a nursing procedure with ease and deftness, a. Based on the actual and potential problems that were
save time and effort identified and prioritized

b. Most important principle i. Goal setting

i. Minimize if not prevent the spread of any 1. Declaration of purpose or intent


infection that gives essential direction to
action
c. Important points to consider in the use of the bag
ii. Constructing plan of action
i. Contain all necessary articles
1. Concerned with choosing from
ii. Cleaned very often among the possible courses of
action
iii. Well protected
iii. Developing an operational plan
iv. Arrangement-most convenient
1. Establishing priorities, phase and
coordinate activities

COMMUNITY HEALTH NURSING PROCESS 2. Plans of care are prioritized in


order of urgency

3. Implementation of planned care


Central to all nursing functions
a. Involves various nursing interventions which have been
determined by the goals/objectives that have been
previously set
14
b. Involves the patient and his/her family in the care 1. Private sector
provided in order to motivate them to assume
responsibility for care a. Largely market oriented

4. Evaluation of care and services provided b. Health care is paid through user fees at the point of
service
THE PUBLIC HEALTH NURSE
c. Includes profit and non-profit health providers

d. Includes providing health services in


Qualifications and Functions
i. Clinics
Must be professionally qualified and licensed to practice in the arena of public
health nursing ii. Hospitals

Consistent with the nursing law of 2002 (RA 9173) iii. Health insurance

I. Management function e. Manufacture of

a. Inherent in the practice of PHN i. Medicines

b. Organizes the nursing service of the local health agency ii. Vaccines

II. Supervisory function iii. Medical supplies

a. Supervisor of the midwives and other health workers iv. Medical equipment

III. Nursing care function v. Other health and nutrition products

a. Inherent function of the nurse vi. Research and development

b. Based on the science of art and caring vii. Human resource development

c. Caring for all levels of clientele toward health promotion and 2. Public sector
disease prevention
a. largely financed through a tax-based budgeting system at
IV. Collaborating and coordinating function both national and local levels

a. Care coordinators for communities and their members b. health care is generally given free at the point of service

b. Establishes linkages and collaborative relationships with other c. consist of the national and local government agencies
health professionals, government agencies, private sectors,
NGO’s people’s organizations to address health problems

V. Health promotion and education function NATIONAL LEVEL

a. Activities goes beyond health teachings and health information 1. Department of Health
campaigns
• Mandated as the lead agency in health
VI. Training function
• Maintains specialty hospitals, regional hospitals and medical
a. Initiates the formulation of staff development and training
centers
programs for midwives and other auxiliary workers

• Maintains provincial health teams made up of DOH


VII. Research function
representatives to the local health boards and personnel
involved in CDC, specifically for malaria and schistosomiasis
a. Participates in the conduct of research and utilizes research
findings in her practice
2. Philippine General Hospital

i. Disease surveillance
• Part of national level which provide health care services
1. Measure the magnitude of the problem

2. Measure the effect of the control


program LOCAL LEVEL (LOCAL HEALTH SYSTEM)

THE PHILIPINE HEALTH CARE DELIVERY SYSTEM • Run by LGU

1. Provincial government

Major players of the HCDS o Provincial and District hospitals

15
2. City/Municipal government
• Act No. 4007 (Reorganization Act of 1932) reverted back the
Philippine Health Service into the Bureau of Health and combined the
o Health centers/RHU
Bureau of Public Welfare under the Office of the Commissioner of
Health and Public Welfare
o Barangay health stations

LOCAL CHIEF EXECUTIVE


PHILIPPINE COMMONWEALTH AND THE JAPANESE OCCUPATION (1935-
• Chaired the local health board 1945)

• Function is mainly to serve as advisory body to the local executive


and the sanggunian or local legislative council on health-related
matters May 31, 1939

• Commonwealth Act No. 430 created the Department of Public


PHILIPPINE DEPARTMENT OF HEALTH Health and Welfare

HISTORICAL BACKGROUND January 7, 1941

(PRE-SPANISH and SPANISH PERIOD) • EO No. 317 fully implemented Commonwealth Act No. 430

January 1, 1951

1888
• Office of the President of the Sanitary District was converted into
RHU carrying out 7 basic health services; Maternal and Child Health,
• Superior board of health and charity was created by the Spaniards
environmental Health, CDC, Vital Statistics, Medical Care, Health
which established a hospital system and a board of vaccination
Education and Public Health Nursing

June 23, 1898


February 20 1958

• Department of Public Works, Education and Hygiene was created by


virtue of decree signed by President Emilio Aguinaldo • EO No. 288 effort to decentralize governance of health service. An
office of the regional health director was created in 8 regions and all
September 29, 1898 health services were decentralized to the regional, provincial and
municipal levels

• General Orders No. 15 established the Board of Health for the City
1970
of Manila
• Restructured Health Care Delivery System was conceptualized,
July 1, 1901
classified health services into Primary, Secondary and Tertiary

• Act No. 157 created Board of Health for the Philippine Islands, also June 2, 1978
functioned as the Local Health Board of Manila
• PD 1397 renamed the Department of Health to the Ministry of Health
December 2, 1901

December 2, 1982
• Act Nos. 307, 308 established the Provincial and Municipal Boards
completing the health organization in accordance with the territorial
• EO No. 851 created Integrated Provincial Health Office
division of the islands

• Board of Health for the Philippine Islands became Insular Board of April 13, 987
Health
• EO No. 119 transformed the Ministry of Health back to the
October 26, 1905 Department of Health

• Act No. 1407 abolished the Insular Board of Health and replaced by October 10, 1991
the Bureau of Health under the Department of Interior
• RA 7160 (Local Government Code) provided for the decentralization
• Act No. 1487 (1906) replaced the provincial boards of health with of the entire government; DOH changed its role from one of
implementation to one of governance
district health officers

May 24, 1999


1915

• Act No. 2468 transformed the BOH into a commissioned service


• EO No. 102 (Redirecting the Functions and Operations of the DOH)
granted the DOH to proceed with its Rationalization and Streamlining
called the Philippine Health Service
Plan.
1932

16
• Mandates the DOH to provide assistance to LGU, people’s 6. Burden of disease is heaviest on the poor
organization and other members of civic society in effectively
implementing programs, projects and services that will

o Promote the health and well being of every Filipino; Reason for the existence of the above conditions

o Prevent and control diseases among population at risk; 1. Inappropriate health delivery system – shown by an inefficient and
poorly targeted hospital system ineffective mechanism for providing
o Protect individuals, families and communities exposed to public health programs on top of health human resources
hazards and risks; maldistribution

o Treat, manage and rehabilitate individuals affected by 2. Inadequate regulatory mechanisms for health services resulting to
poor quality of health care, high cost of privately provided health
diseases and disability
services, high cost of drugs and presence of low quality of drugs in
the market
1999-2004

3. Poor health care financing and inefficient sourcing or generation of


Development of Health Sector Reform Agenda
funds for healthcare

ROLES AND FUNCTIONS OF DOH (Mandated by the EO No. 102)


Framework for the implementation of HSRA: FOURmula ONE for Health

ROLE

• Providing technical and other resource assistance


FOURmula ONE for Health is the implementation framework for health sector
reforms in the Philippines for the medium term covering 2005-2010. It is
GENERAL FUNCTIONS UNDER THREE SPECIFIC ROLES designed to implement critical health interventions as a single package, backed
by effective management infrastructure and financing arrangements.
1. Leadership in Health

2. Enabler and Capacity Builder


FOURmula ONE for Health engages the entire health sector, including the
3. Administrator of Specific Services public and private sectors, national agencies and local government units,
external development agencies, and civil society to get involved in the
implementation of health reforms. It is an invitation to join the collective race
against fragmentation of the health system of the country, against the inequity of
VISION healthcare and the impoverishing effects of ill-health. With a robust and united
health sector, we can win the race towards better health and a brighter future for
The DOH is the leader, staunch advocate and model in promoting “Health for All generations to come.
in the Philippines”.

Goals of FOURmula one for Health


MISSION
Starting the Race with the End in Mind:
Guarantee equitable, sustainable and quality health for all Filipinos, especially Fourmula One for Health Goals and Objectives
the poor and shall lead the quest for excellence in health
Over-all Goals:
The implementation of FOURmula ONE for Health is directed towards achieving
the following end goals, in consonance with the health system goals identified by
GOAL: Health Sector Reform Agenda (HSRA) the World Health Organization, the Millennium Development Goals, and the
Medium Term Philippine Development Plan:
Health Sector Reform is the overriding goal of the DOH. Support mechanisms
will be through ¹sound organizational development, ²strong policies, ³systems • Better health outcomes
and procedures, ⁴capable of human resources and ⁵adequate financial resources • More responsive health system
• More equitable healthcare financing.

Rationale for Health Sector Reform

1. Slowing down in the reduction in the IMR and the MMR General Objective:
FOURmula ONE for Health is aimed at achieving critical reforms with speed,
precision and effective coordination directed at improving the quality,
2. Persistence of large variations in health status across population efficiency, effectiveness and equity of the Philippine health system in a
groups and geographic areas manner that is felt and appreciated by Filipinos, especially the poor.

3. High burden from infectious diseases

4. Rising burden from chronic and degenerative diseases Specific Objectives:


Fourmula One for Health will strive, within the medium term, to:
5. Unattended emerging health risks from environmental and work
related factors • Secure more, better and sustained financing for health

17


Assure the quality and affordability of health goods and services
Ensure access to and availability of essential and basic health
• Willingness of the LGU to participate in the FOURmula ONE for
Health implementation, in terms of willingness to provide the
packages
requisite counterpart resources, and willingness to enter into
• Improve performance of the health system
formal national government to local government, inter-local
government and government to private sector networking,
partnership and resource sharing arrangements;
• Presence of local initiatives or start-up activities relevant to
Defining the Rules of Engagement: FOURmula ONE strategies, to include, but not limited to:
Seven (7) General Guidelines for Health Reform Implementation development of inter-local health zones, enrollment of indigents
into the social health insurance system, improvement in drug
management systems, among others;
F1 Rule No.1: • Relatively high feasibility of success and sustainability, to include
factors such as capacity to enter into loans, capacity to absorb
investments and sustain the reform process, etc.; and
FOURmula ONE for Health will organize the critical reform initiatives • Availability of funds from GOP and external sources for capital
into four implementation components, namely, Financing, Regulation, Service
investment requirements.
Delivery and Governance.

F1 Rule No. 2:

Carrying out the Game Plan:


The implementation of FOURmula ONE for Health will focus on a few
Winning Strategies to Attain FOURmula ONE for Health Component-
manageable and critical interventions. Such interventions will be identified using
Specific Objectives
the following criteria:

• Doable given available resources - Critical interventions identified for


each component must be deemed doable given the available time, F1 Component No. 1: HEALTH FINANCING
human and financial resources.
• Sufficient groundwork and buy-in - The chosen interventions must be
Objective: The objective of financing reforms under FOURmula ONE
backed by sufficient groundwork and buy-in from implementation for Health is to secure more, better and sustained investments in health to
partners, especially in the development of reform packages for local provide equity and improve health outcomes, especially for the poor.
implementation.
• Triggers a reform chain reaction - These critical interventions must
F1 Component No.2: HEALTH REGULATION
be able to trigger a chain of reaction that will spur the
implementation of other FOURmula ONE for Health interventions,
within and across the four components. Objective: The main objective of health regulation under FOURmula
• Produces tangible results and generates public support - These
ONE for Health is assuring access to quality and affordable health products,
devices, facilities and services, especially those commonly used by the poor.
critical interventions must be able to show tangible results within
the immediate and medium terms, which in turn generate support
and cooperation from the public; F1 Component No. 3: HEALTH SERVICE DELIVERY

F1 Rule No. 3: Objective: FOURmula ONE for Health interventions in service


delivery are aimed at improving the accessibility and availability of basic and
essential health care for all, particularly the poor. This shall cover all public and
The reforms will be implemented under a sector-wide approach, private facilities and services
which encompasses a management perspective that covers the entire health
sector and an investment portfolio that encompasses all sources.
F1 Component No.4: GOOD GOVERNANCE IN HEALTH
F1 Rule No. 4:
Objective: The objective of good governance in health is to improve
health systems performance at the national and local levels. FOURmula ONE for
The National Health Insurance Program (NHIP) will serve as the main Health will introduce interventions to improve governance in local health systems,
lever to effect desired changes and outcomes in each of the four implementation improve coordination across local health systems, enhance effective private-
components, where the main functions of the NHIP including enrollment, public partnership, and improve national capacities to manage the health sector.
accreditation, benefit delivery, provider payment and investment are employed to
leverage the attainment of the targets for each of the reform components.

F1 Rule No. 5:
Governance in local health systems may be improved by undertaking the
following strategies:
The functional and financial management arrangements will be
defined in terms of specific offices having clear mandates, performance targets
and support systems, within well-defined time frames in the implementation of FOUR-IN-ONE Convergence Sites have to be established. These convergence
reforms within each component. sites will undertake integrated implementation of FOURmula ONE for Health
components in appropriately delineated localities or inter-local health zones.
F1 Rule No. 6:

The functional clustering of teams and assignment of specific Team


Leaders shall facilitate implementation, monitoring and supervision in a A FOURmula ONE for Health LGU Scorecard will be developed and employed
coordinative manner and shall not, in any way, prejudice the corporate nature of to track the progress and compare the performance of various localities or inter-
the DOH-attached agencies nor the autonomy of Local Government Units. local health zones.

F1 Rule No. 7:

The selection of FOUR-in-ONE Convergence Sites will be governed by the A FOURmula ONE for Health Professional Development and Career Track
following criteria: will be institutionalized where competent and dedicated health personnel will
18
provide quality health services and sound advice to local chief executives with defined geographical area participate together in providing quality
regard to health reforms. equitable and accessible health care with Inter Local Government
Unit (ILGU) partnership as the basic framework.
FOURmula ONE for Health is an overarching philosophy to achieve the end
goals of better health outcomes, a responsive health system and equitable health • Overall concept is clustering municipalities into Inter Local Health
care financing. It is directed towards ensuring accessible, affordable health care Zone (ILHZ)
especially for the more disadvantaged and vulnerable sectors of the population.
o Each IHLZ has a defined population within a defined
geographical area and comprises a central referral
hospital and a number of primary level facilities such as
Objectives of the Health Sector RHU and BHSs

1. Improve the general health status of the population

2. Reduce morbidity and mortality from certain diseases Importance of ILHS

3. Eliminate certain diseases as public health problems 1. Re-integrate hospital and public health service for a holistic delivery
of health services
4. Promote healthy lifestyle and environmental health
2. Identify areas of complementation of the stakeholders in the delivery
5. Protect vulnerable groups with special health and nutrition needs of health services

6. Strengthen national and local health systems to ensure quality and a. Stakeholders include:
safety of health goods and services
i. LGUs at all levels
7. Pursue public health and hospital reforms
ii. DOH
8. Reduce the cost and ensure the quality of essential drugs
iii. PHIC
9. Institute health regulatory reforms to ensure quality and safety of
health goods and services iv. NGOs

10. Strengthen health governance and management support systems v. Private sectors

11. Institute safety nets for the vulnerable and marginalized groups vi. Communities

12. Expand the coverage of social health insurance

13. Mobilize more resources for health Expected achievement of the ILHS

14. Improve efficiency in the allocation, production and utilization of 1. Universal coverage of health insurance
resources for health
2. Improved quality of Hospital and RHU services

3. Effective referral system


LOCAL HEALTH SYSTEM (Created under RA 7160)
4. Integrated planning

5. Appropriate health information system


Objectives
6. Improved drug management system
1. Establish local health systems for effective and efficient delivery of
health care services 7. Developed human resources

2. Upgrade the health care management and service capability of health 8. Effective leadership through inter-LGU corporation
care facilities
9. Financially visible or self sustaining hospitals
3. Promote inter-LGU linkages and cost sharing schemes including local
health care financing systems for better utilization of local health 10. Integration of public health and curative hospital care
resources
11. Strengthened cooperation between LGU and health sectors
4. Foster participation of the private sector, NGOs and communities in
local health systems development

5. Ensure the quality of health service delivery at the local level Guiding principles in developing the ILHS

1. Financial and administrative autonomy of the provincial and municipal


administrations
INTER LOCAL HEALTH SYSTEM
2. Strong political support
• System of health care similar to a district health system in which
individuals, communities and all other health care providers in a well- 3. Strategic synergies and partnerships

19
4. Community participation • PHC is a strategy, which focuses responsibility for health on the
individual, his family and the community
5. Equity of access to health services by the population, especially the
poor • PHC includes full participation and active involvement of the
community towards the development of self-reliant people, capable of
6. Affordability of health services achieving an acceptable level of health and well being

7. Appropriateness of health programs • PHC recognizes the interrelationship between health and the overall
political, socio-cultural and economic development of society
8. Decentralized management

9. Sustainability of health initiatives


Elements/Components of PHC
10. Upholding of standards of quality health service
1. Environmental Sanitation

2. Control of communicable diseases


Composition of the ILHS
3. Immunization
1. People – number of people may vary from zone to zone; ideal health
district would have a population size between 100,000 to 500,000 for 4. Health Education
optimum efficiency and effectiveness
5. Maternal and Child Health and Family Planning
2. Boundaries – clear boundaries between ILHS determine the
accountability and responsibility of health service providers, 6. Adequate Food and Proper Nutrition
geographical locations and access to referral facilities such as district
hospitals are the usual basic in forming the boundaries
7. Provision of Medical Care and Emergency Treatment

3. Health facilities – district or provincial hospital, number of RHU &


8. Treatment of Locally Endemic Diseases
BHS and other health services deciding to work together as an
integrated health system
9. Provision of Essential Drugs

4. Health workers – right unit of health providers is needed to deliver


comprehensive health services

Strategies

1. Reorientation and reorganization of the national health care system


PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH
(RA 7160)
CARE SERVICE

2. Effective preparation and enabling process for health action at all


levels

PRIMARY HEALTH CARE


3. Mobilization of the people to know their communities and identifying
their basic health care needs with the end view of providing
• Essential health care made universally accessible to individuals and appropriate solutions leading to self-reliance and self determination
families in the community by means of acceptable to them through
their full participation and at a cost that the community and country
4. Development and utilization of appropriate technology focusing on
can afford at every stage of development
local indigenous resources available in and acceptable to the
community

5. Organization of communities arising from their expressed needs


Primary health care was declared during the First International Conference on which they have decided to address and that this is continually
PHC held in Alma Ata USSR on September 6 – 12, 1978 by WHO with a goal of evolving in pursuit of their own development
“Health for All by the year 2000”
6. Increase opportunities for community participation in local level
planning, management, monitoring and evaluation within the context
of regional and national objectives
Primary Health Care was adopted in the Philippines through LOI 949 signed by
Pres. Marcos on October 19, 1979 and has an underlying theme of “Health in the 7. Development of intra-sectoral linkages with other government and
hands of the People by 2020” private agencies so that programs of the health sector is closely
linked with those of other socio-economic sectors at the national,
intermediate and community levels

Concept of PHC is characterized by; 8. Emphasizing partnership so that the health workers and the
community leaders/members view each other as partners rather than
• Partnership and empowerment of the people – shall permeate as merely providers and receiver of health care respectively

the core strategy in the effective provision of essential health services


that are community based, accessible, acceptable and sustainable at
a cost which the community and the government can afford
Framework for meeting the goal of PHC

20
• Organizational strategy – calls for active and continuing partnership
c. Serves as a referral center for the primary health facilities

among the communities, private and government agencies in health


d. Capable of performing minor surgeries and perform some
development
simple laboratory examinations

3. Tertiary Level of Care

Four cornerstones/Pillars in PHC


a. Rendered by specialists in health facilities including
medical centers as well as regional and provincial
1. Active community participation hospitals and specialized hospitals

2. Intra and Inter-sectoral linkages b. Referral center for the secondary care facilities

3. Use of appropriate technology

4. Support mechanisms made available

Types of PHC workers

Vary in different communities depending upon;


By Jhun Echipare

1. Available health manpower resources


Health Programs
2. Local health needs and problems
- Adolescent and Youth Health and Development Program
3. Political and financial feasibility - Botika Ng Barangay
- Breastfeeding Program / Mother and Baby Friendly Hospital Initiative
- Blood Donation Program
- Child Health
- Diabetes Mellitus Prevention Program
Two levels of PHC workers - Dengue Control Program
- Dental Health Program
1. Village or Barangay Health Workers - Doctors to the Barrios (DttB) Program
- Emerging Disease Control Program
- Environmental Health
2. Intermediate Level Health Workers - Expanded Program on Immunization
- Family Planning
a. General medical practicioners - Food and Waterborne Diseases Prevention and Control Program
- Food Fortification Program
- FOURmula One
b. PHN
- Garantisadong Pambata
- GMA 50 / Parallel Drug Importation (PDI)
c. RSI - Healthy Lifestyle Program
- Knock-Out Tigdas
d. RHM - Leprosy Control Program
- Malaria Control Program
- Measles Elimination Campaign (Ligtas Tigdas)
- National Cardiovascular Disease Prevention and Control Program
- National Filariasis Elimination Program
LEVELS OF HEALTH CARE AND REFERRAL SYSTEM - National Mental Health Program
- Natural Family Planning
- Newborn Screening
1. Primary Level of Care
- Nutrition
- Occupational Health Program
a. Devolved to the cities and municipalities - Health Development Program for Older Persons (Elderly Health)
- Persons with Disabilities Program
b. Health care provided by the center physicians, PHN, - Prevention of Blindness Program
RHM, BHW, TBAs and others - Rabies Control Program
- Safe Motherhood and Women's Health
- Schistosomiasis Control Program
c. Usually the first point of contact between the community - Smoking Cessation Program
members and other levels of health facility - Soil Transmitted Helmenthiasis
- TB Control Program
2. Secondary Level of Care
Presidential Decree
a. Given by physicians with basic health training

b. Usually given in health facilities either privately owned or • Presidential Decree 881
government operated such as January 30, 1976
Empowering the Secretary of Health to regulate the labeling, sale and
distribution of hazardous substances
i. Infirmaries
• Presidential Decree No. 856
ii. Municipal and district hospitals Code on Sanitation of the Philippines
(with Implementing Rules and Regulations)

iii. Out-patient departments of provincial • Presidential Decree No. 522


hospitals Prescribing Sanitation Requirements for the Operation of

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Establishments and Facilities for the Protection and Convenience of
the Travelling Public
• Presidential Decree No. 651
Requiring the Registration of Births and Deaths in the Philippines
which occured from January 1, 1974 and thereafter
• Presidential Decree No. 996
Providing for Compulsory Basic Immunization for Infants and children
below eight years of age
• Presidential Decree No. 498
Amending sections two, three, four, seven, eight, eleven, thirteen,
sixteen, seventeen, twenty-one and twenty-nine of Republic Act No.
5527, also known as the Philippine Medical Technology Act of 1969
• Presidential Decree No. 965
A Decree Requiring Applicant for Marriage License to Receive
Instructions on Family Planning and Responsible Parenthood
• Presidential Decree No. 1631
Creating the Lunsod ng Kabataan
• Presidential Decree No. 1823
Creating the Lung Center of the Philippines
• Presidential Decree No. 384
Amending Republic Act Numbered 4073, entitled an An Act Further
LIberalizing the Treatment of Leprosy by Amending and Repealing
certain Sections of the REvised Administrative Code

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