COMMUNITY HEALTH NURSING

Content Outline
Part Part Part Part Part Part Part Part Part Part Part Part Part Part Part Part Part Part 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Definition of Terms Basic Principles of CHN Roles and Functions of the PHN Levels of Care Levels of Clientele Health Care Delivery System Primary Health Care Ten Herbal Plants Recommended by the DOH Family Nursing Process Community Diagnosis COPAR Selected Public Health Situation Vital Statistics Epidemiology Demography Target Setting Environmental Sanitation DOH National Events

PART 1 DEFINITION OF TERMS

A. Public Health Science and Art of Preventing Disease, Prolonging Life, Promoting Health and efficiency through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to Enable Every Citizen to Realize His Birthright to Health and Longevity - Dr. C.E. Winslow Art of applying Science in the Context of Politics so as to Reduce Inequalities in Health while ensuring the best health for the greatest number - WHO B. Public Health Nursing Special Field of Nursing that combines the skills of nursing, public health, and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability. - WHO C. Community Health Nursing Service rendered by a professional nurse with communities, groups, families, individuals at home, in health centers, in clinics, in schools, in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation. - Ruth B. Freeman Nursing Practice in a wide variety of community services and consumer advocate areas, and in a variety of roles, at times including independent practice community nursing is certainly not confined to public health nursing agencies. - Jacobson The utilization of the Nursing Process in the Different Levels of Clientele-Individuals, Families, Population Groups and Communities, concerned with the Promotion of Health, Prevention of Disease and Disability and Rehabilitation

Dr. Araceli Maglaya

Part 2 Basic Principles of CHN

A. Brief History of Nursing The Community is the patient in CHN; The Family is the Unit of Care; and there are four levels of clientele: Individual, Family, Population Group (those who share common characteristics, developmental stages, and common exposure to health problemse.g. children, elderly), and the Community In CHN, the client is considered as an Active Partner, not a passive recipient of care. CHN Practice is affected by developments in Health Technology, in Particular, Changes in Society, in General. The goal of CHN is achieved through Multi-Sectoral Efforts CHN is a part of the Health Care System and the larger Human Services System B. Philosophy of CHN A philosophy is defined as a system of beliefs that provides a basis for a guides action. A philosophy provides the direction and describes the whats, the whys, and the hows of activities within a profession. CHN Practice is guided by the following beliefs:

Humanistic values of the nursing profession upheld Unique and distinct component of health care Multiple factors of health considered Active participation of clients encouraged Nurse considers availability of resources Interdependence among health team members practiced Scientific and up-to-date Tasks of CHN vary with time and place Independence or self-reliance of the people is the end goal Connectedness of health and development regarded

Part 3 Roles and Functions of the Public Health Nurse

A. Roles of the CHN
Clinician or Health Care Provider: utilizes the nursing process in the care of the client in the home setting through home visits and in public health care facilities; conducts referral of patients to appropriate levels of care when necessary Health Educator: utilizes teaching skills to improve the health knowledge, skills and attitude of the individual, family and the community and conducts health information campaigns to various groups for the purpose of health promotion and disease prevention Coordinator and collaborator: establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, non-government organizations and peoples organizations to address health problems Supervisor: monitors and supervises the performance of midwives and other auxiliary health workers; also initiates the formulation of staff development and training programs for midwives and other auxiliary health workers as part of their training function as supervisors Leader and Change Agent: influences people to participate in the overall process of community development Manager: organizes the nursing service component of the local health agency or local government unit; also, as program manager, the PHN is responsible for the delivery of the package of services provided by the health program to target clientele Researcher: participates in the conduct of research and utilizes research findings in practice Be a part in developing an overall health plan, its implementation and evaluation for communities. Provide quality nursing services to the four levels of clientele Maintain coordination/linkages with other health team members, NGO/ government agencies in the provision of public health services Conduct researches relevant to CHN services to improve provision of health care Provide opportunities for professional growth and continuing education for staff development Community Mental Health Nursing: a unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology, community networks, and the basic sciences

B. Responsibilities of the CHN

C. Specialized Fields of CHN

Occupational Health Nursing: the application of nursing principles and procedures conserving the health of workers in all occupation School Health Nursing: the application of nursing theories and principles in the care of the school population

Part 4 Levels of Care

A. The Three Levels of Health Care Services Primary Level of Care: devolved to the cities and municipalities and is the first contact between the community people and the different levels of health facility; refers to health care provided by the health center staff Secondary Level of Care: rendered by physicians with basic health training in district hospitals, provincial hospitals, and city hospitals; these facilities are capable of basic surgical procedures and simple laboratory examinations; serves as referral center of primary health facilities Tertiary Level of Care: rendered by specialists in medical centers, regional hospitals and specialized hospitals like the Lung Center of the Philippines; serves as the referral center of secondary health facilities B. Three levels of Health Care Services and the Two-Way Referral System

National Health Services, Medical Centers, Tertiary Teaching and Training Hospitals Regional Health Services, Regional Medical Centers and Training Hospital Provincial/City Health Services, Provincial /City Hospitals

TERTIAR Y

SECONDAR Y

Emergency / District Hospitals

Rural Health Units, Community Hospitals and Health Centers, Puericulture centers

Barangay Health Station

PRIMAR Y

REFERRAL from the COMMUNITY

*There are TWO LEVELS OF PRIMARY HEALTH CARE WORKERS, namely: 1. Village or Barangay Health Workers: refers to trained community health workers or health auxiliary volunteers or traditional birth attendants or healers 2. Intermediate Level Health Workers: refers to general medical practitioners or their assistants, public health nurse, rural sanitary inspectors, and midwives. C. Types of Primary Health Workers Village / Grassroots Intermediate Level Health Workers E X A M P L E C H A R A C T E R I S T I C S - trained community -health worker -auxiliary health volunteer -traditional birth attendant -initial link, first contact of the community -works in liaison with the local health service workers -provides elementary curative and preventive health care measures -general medical practitioners -public health nurses -midwives

Health Personnel of First-Line Hospitals -physicians -nurses -dentists

-first source of professional health care

-establishes close contact with the village and intermediate level -attends to health health workers to problems beyond the promote the competence of village continuity of care health workers from hospital to community to home -provides support to the frontline health -provides back-up workers in terms of health services for supervision, training, cases requiring referral services and hospital or diagnostic supplies thru linkages facilities not with other sectors available in health

care

Part 5 Levels of Clientele

*Four Levels of Clientele in the Community Setting A. Individual B. Family C. Community D. Population Groups A. Individual -basic approaches in looking at the individual Atomistic: the whole is equal to the sum of its parts Holistic: the whole is NOT equal to the sum of its parts; traces mans relationship in the suprasystem of society B. Family -defined by Murray and Zentner is a small social system and primary reference group made up of two or more persons living together who are related by blood, marriage or adoption or who are living together by arrangement over a period of time. C. Population Groups - a group of people sharing the same characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems * Vulnerable groups: Infants and young children School age Adolescents Mothers Males

Older People

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

Part 6 Health Care Delivery System

HEALTH CARE DELIVERY SYSTEM -the totality of all policies, facilities, equipment, products, human resources and services which addresses the health need, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary MAJOR PLAYERS Public Sector- largely financed thru tax-based budgeting system at both the national and local levels and where health care is generally given free at the point of service a. National Level Department of Health as lead agency b. Local Health system run by local government units

Private Sector- largely market-oriented and where health care is paid through user fees at the point of service

A. THE PUBLIC SECTOR 1. Department of Health Vision: The DOH is the leader, staunch advocate and model in promoting Health for all in the Philippines Mission: Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and shall lead the quest for excellence in health. Roles and Functions: Executive Order 102 has identified the DOH as the national health authority providing technical and other resource assistance to concerned groups. It has three specific roles in the health sector and several functions under each role.

LEADERSHIP IN HEALTH Functions: a. LEADER in the formulation, monitoring and evaluation of national health policies, plans and programs b. ADVOCATE in the adoption of health policies, plans and programs to address national and sectoral concerns c. NATIONAL POLICY AND REGULATORY INSTITUTION where local government units, nongovernmental organizations and other members of the health sector involved in social welfare and development anchor their thrusts and directions for health. ADMINISTRATOR OF SPECIFIC SERVICES Functions: a. MANAGE selected health facilities and hospitals b. ADMINISTER direct services for emergent health concerns that require new complicated technologies c. PROVIDE emergency health response services including referral and networking system for trauma, injuries and catastrophic events, and, in cases of epidemic widespread public danger upon the direction of the President and in consultation with the concerned LGU d. ADMINISTER special components of specific programs like tuberculosis, HIV-AIDS, etc. CAPACITY BUILDER AND ENABLER Functions: a. ENSURE highest achievable standards of quality health care, health promotion and health protection b. INNOVATE new strategies in health to improve the effectiveness of health programs c. INITIATE public discussion on health issues and disseminate policy research outputs to ensure informed public participation in policy decision-making d. OVERSEE implementation, monitoring and evaluation of national health plans, programs and policies

Goal of the DOH: Implementation of Health Sector

Reform Agenda (HSRA)

 Framework for the implementation of the HSRA:

FOURmula ONE for Health a. FOURmula ONE for health intends to implement critical interventions as a single package backed by effective management infrastructure and financing arrangements thru a sector-wide approach b. This is directed towards ensuring accessible, affordable quality health care especially for the more disadvantaged and vulnerable sectors of the population c. This strategy has FOUR ELEMENTS 1. Good Governance to enhance health system performance at the national and local levels. 2. Health Financing to foster greater, better and sustained investments in health 3. Health Regulation to ensure the quality and affordability of health goods and services 4. Health Service Delivery to improve and ensure the accessibility and availability of basic and essential health care in both public and private facilities and services Objectives of the Health Sector - to facilitate understanding the objectives of the health sector could be divided into 4 general objectives, namely: Improve Health Status of the Population a. Improve the general health status of the population b. Reduce morbidity and mortality from certain diseases c. Eliminate certain diseases as public health problems d. Promote health lifestyle and environmental health e. Protect vulnerable groups with special health and nutritional needs Ensure Quality Service Delivery

a. Strengthen national and local health systems to ensure better health service delivery b. Pursue public health and hospital reforms c. Reduce the cost and ensure the quality and safety of health goods and services d. Strengthen health governance and management support systems Improve Support system for the Vulnerable and Marginalized Groups a. Institute safety nets for the vulnerable and marginalized groups

Implement Proper Resource Management a. Expand the coverage of social health insurance b. Mobilize more resources for health c. Improve efficiency in the allocation, production and utilization of resources for health Major Health Plans towards Health in the Hands of the People in the Year 2020 A Healthy BARRIO should be: a. Residents actively participate in attaining good health; they are PARTNERS in health care. b. Highlight Project: BOTIKA SA PASO CAMPAIGN c. Goal: to maintain herbal plants in pots for family use A Healthy CITY should be: a. The physical environment in the workplace, streets, and public places promote health, safety, order and cleanliness through structural manpower support b. Health- Related Strategies: Construction of well-maintained, income generating public

toilets; designation of a pook-sakayan, pook-babaan A Healthy EATING PLACE should be: a. Eating place where: -safe and properly prepared, stored and transferred foods -nutritious foods and drinks are served. b. Complies with the following sanitation -safe, environment-friendly -with clean restrooms -food handlers are medically fit A Healthy MARKET should be: a. Adequate water supply b. Proper drainage c. Well-maintained toilet facilities d. Proper garbage and waste disposal e. Cleanliness maintained f. Affordable quality foods A Healthy HOSPITAL should be: a. A Center of Wellness b. Promotes Preventive care c. Patient-centered A Healthy STREET should be: a. Well-maintained roads and public waiting areas b. Clean and obstruction free sidewalks c. With minimal traffic problems d. With adequate strict law enforcement e. Project: Pook Tawiran f. Goal: to promote and reorient people especially erring pedestrians on the use of pedestrian crossings

standards:

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

GOVERNOR Provincial Level Provincial Health Office Provincial Hospital District Hospital MAYOR Municipal Level Municipal Health Office Municipal Health Board
Other health and medical facilities

Provincial Health Board

Rural Health Unit/ Health Center

Barangay Health Station

B. The Private Sector - composed of both commercial and business organizations with its market or profit orientation and non-business organizations with its service orientation

Part 7 Primary Health Care

Primary Health Care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford at every stage of development Conceptual Framework: a. Health is a fundamental human right b. Health is both an individual and collective responsibility c. Health should be an equal opportunity to all d. Health is an essential element of socio-economic development

Translated into action, the PHC APPROACH focuses on:

Partnership with the community Equitable distribution of health resources Organized and appropriate health system infrastructure Prevention of disease and promotion of health as focus Linked multisectorally Emphasis on appropriate technology

PHC GOAL (1978): Health for all by the year 2000 PHC was declared in Alma-Ata, USSR during the First International Conference on PHC held on September 612, 1978 through the sponsorship of WHO and UNICEF LEGAL BASIS OF PHC IN THE PHILIPPINES- Letter of Instruction(LOI) 949 signed in October 19, 1979 by former President Ferdinand E. Marcos UNDERLYING THEME of the Philippine implementation of PHC: Health in the Hands of the People by 2020

5As of Health Care according to PHC a. Available b. Accessible c. Affordable d. Acceptable e. Attainable *PHC as a service delivery policy of the DOH permeates all strategies and thrusts of government health programs from the national to the local and community levels

Dimension Goal Focus of Care Setting for Services

People Structure

Process Technology

Outcome

Commercialized Health Primary Health Care Care Absence of disease for the Prevention of disease individual Socio-economic development Sick Sick and well individuals Hospital-based Satellite Health Centers Urban-Centered Community Health Centers Rural-Based Accessible only to a few Accessible to all people Passive recipients of Active participants in health health care care Health is isolated from Inter- and intra- sectoral other sectors of society linkaging allows health to be integrated with over-all socio-economic development efforts Decision-making from top- Decision-making from down bottom-top Curative services based Promotive and preventive on modern medicine and services blend traditional sophisticated technology medicine with modern Physician dominated medicine Appropriate technology for frontline health care Reliance on health People empowerment or professionals self-reliance Four Cornerstones or Pillars of PHC

Use of appropriate technology Support mechanism made available Active community participation

Intra- and inter-sectoral linkage

a. APPROPRIATE TECHNOLOGY implies the use of

methods, procedures, techniques, equipment or materials that are not only scientifically sound but also provides a socially and environmentally acceptable service or product at the least economic cost

CRITERIA used in determining the appropriateness of technology: Acceptability: measured in terms of the degree of utilization of the people Complexity: should be simple and easy to apply under local conditions Cost: should be affordable Effectiveness: should produce the desired effect Safety: effect of utilization should produce no harm Scope of Technology: serves a variety of purposes Feasibility: compatible with local conditions
b. MULTISECTORAL APPROACH recognizes intersectoral

and intrasectoral linkages in health. With intersectoral linkages, PHC recognizes the integration of health plans with other sectors for TOTAL community development. Elements/ Components of Primary Health Care

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

Part 8 Ten Herbal Plants Recommended by DOH

10 Medicinal Plants (LUBBY SANTA)

Lagundi
Indications: cough, asthma, fever, muscle pain

 Preparation: decoction or syrup

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

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

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

Yerba Buena
Indications: for muscle pain Preparation: decoction

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

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

Niyug-niyogan
Indications: for intestinal infestation with ascaris lumbricoides Preparation: prepare dried, mature niyug-niyugan seeds

Tsaang gubat
Indications: stomachache Preparation: decoction

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

Part 9 Family Nursing Process

Initial Data base a. Family structure and characteristics b. Socio-economic and cultural factors c. Environmental factors d. Health assessment of each member e. Value placed on prevention of disease First Level Assessment a. Wellness condition stated as POTENTIAL or READINESS a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher one b. Health Threats conditions that are conducive to disease, accident or failure to realize ones health potential c. Health deficits instances of failure in health maintenance (disease, disability or developmental lag) d. Stress Points/ Foreseeable crisis situation anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources Second Level Assessment (based on Freemans Family Health Tasks): a. Ability to recognize the existence of a problem b. Ability to make decisions with respect to taking appropriate health actions c. Ability to provide nursing care to the affected family member d. Ability to provide a home environment that is conducive to health maintenance and personal development e. Ability to utilize community resources for health care Problem Prioritization a. Nature of the Problem Wellness condition Health deficits Health threats

 Foreseeable crisis b. Preventive Potential refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration c. Modifiability of the Condition refers to the probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention d. Salience refers to the familys perception and evaluation of the problems in terms of seriousness and urgency of attention needed Scale for Ranking Health Conditions and Problems according to Priorities Criteria Score Nature of the Condition Wellness State 3 Health Deficit 3 Health Threat 2 Foreseeable Crisis 1 Modifiability of the Condition Easily Modifiable 2 Partially Modifiable 1 Not Modifiable 0 Preventive Potential High 2 Moderate 2 Low 1 Salience A condition needing 2 immediate attention A condition not 1 needing immediate attention Not perceived as a 0 condition needing change Weight

Part 10 Community Diagnosis

A. What is Community Diagnosis? As a profile, it is a description of the communitys state of health as determined by its physical, economic, political and social factors. It defines the community and states community problems As a process, it is a continuous learning experience for the nurse/program coordinator and the staff, as well as the community people. B. Why undertake Community Diagnosis? To have a clear picture of the problems of the community and to identify the resources available to the community people. Community diagnosis enables the nurse/program coordinator to set priorities for planning and developing programs of health care for the community. C. What are the Types of Community Diagnosis? The types of a community diagnosis may vary according to: The objectives or degree of detail or depth of the assessment; The resources; and The time available for the nurse to conduct the community diagnosis a. Comprehensive Community diagnosis aims to obtain general information about the community or a certain population b. Problem-oriented Community diagnosis- type of assessment that responds to a particular need D. What are the elements of a Comprehensive Community Diagnosis?

1. Demographic Variables -should show the size, composition and geographical distribution of the population 2. Socio-economic and Cultural Variables a. Social indicators b. Economic indicators c. Environmental indicators d. Cultural factors e. Other factors that may directly or indirectly affect the health status of the community 3. Health and Illness Pattern -if the nurse has access to recent and reliable secondary data, then those could be used 4. Health Resources -refer to manpower, institutional and material resources provided not only by the state but also those that are contributed by the private sector and other non-government organizations 5. Political/ Leadership Patterns -reflect the action potential of the state and it people to address the health needs and problems of the community; mirrors the sensitivity of the government to the peoples struggle for better lives E. What are the sources of data in the conduct of the community diagnosis? 1. Primary Data - source would be the community people through survey, interview, focused group discussions, observation and through the actual minutes of community meetings
2. Secondary data source would be organizational records of the

program, health center records and other public records through review of records F. What are the steps in Conducting a Community Diagnosis 1. Planning a. Determining the Objectives nurse decides on the depth and scope of the data he/she needs to gather; regardless of

the type of community diagnosis to be conducted, the nurse must determine the occurrence and distribution of selected environmental, socio-economic and behavioral conditions important to disease prevention and wellness promotion
b. Defining the Study Population based on the objectives,

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

c. Preparation of the community courtesy calls for

meetings are a must to enable the nurse to formulate the community diagnosis objectives with the key leaders of the community d. Choosing the methodology and instrument of community diagnosis *Three Levels of Data Gathering 1. Community People 2. Community health workers 3. Program staff *INSTRUMENTS may be following: Survey questionnaire Observation checklist Interview guide 2. Implementation a. Actual data gathering b. Collation/ organization of data c. Presentation of data d. Analysis of data e. Identifying the community health nursing problems i. Health Status Problems may be described in terms of increased or decreased morbidity, mortality or fertility
ii.

Health Resources Problems - they may be described in terms of lack of or absence of manpower, money, materials or institutions necessary to solve health problems

Health- Related Problems they maybe described in terms of existence of social, economic, environmental and political factors aggravate the illness-inducing situations in the community f. Priority- setting of the community Health Nursing Problems g. Feedback to the Community community meetings are held to inform the community people of the results of the community diagnosis h. Action Planning action programs are the activities necessitated by the results of the community diagnosis.
iii. 3. Evaluation an evaluation scheme is necessary to measure the

achievements of progress of the program based on the action plan made through the Community Diagnosis.

Part 11 COPAR
A. Definitions A social development approach that aims to transform the apathetic, individualistic, and voiceless poor into dynamic, participatory and politically responsive community A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community B. Importance of COPAR As important tool for community development and people empowerment as this helps the community workers to generate community participation in development activities Prepares people/clients to eventually take over the management of a development program/s in the future Maximizes community participation and involvement; community resources are mobilized for community services

C. Principles of COPAR People, especially the most oppressed , exploited and deprived sectors are open to change, have the capacity to change, and are able to bring about change COPAR should be based on the interests of the poorest sectors of society COPAR should lead to self-reliant community and society D. Processes/ Methods Used A Progressive Cycle of Action- Reflection- Action which begins with small, local, concrete issues, identified by the people and the evaluation and reflection of and on the action taken by them Consciousness RAISING through experiential learning is central to COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action COPAR is Participatory and Mass-Based because it is primarily directed towards and biased in favor of the poor, the powerless and the oppressed COPAR is Group-centered and not Leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity E. Phases of the COPAR Process 1. Pre-Entry Phase The initial phase of the organizing process where the community organizer looks for communities to serve/help Designing criteria for the selection of site Actually selecting the site for community care 2. Entry Phase Sometimes called the social preparation phase as the activities done here include the sensitization of the people on the critical events in their life , motivating them to share their concerns and eventually mobilizing them to take collective action on these 3. Organization Building Phase

 Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementing, and evaluating community-wide activities Conduct of trainings for the organized leaders or groups to develop their asks in managing their own concerns/programs 4. Sustenance and Strengthening Phase Occurs when the community organization has already been established and the community members are already actively participating in community- wide undertakings The different committees set-up in the organization-building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs, with overall guidance from the community- wide organization Strategies: *education and training *networking and linkages *developing secondary leaders

Part 12 Selected Public Health Programs

Part 13 Vital Statistics

VITAL STATISTICS the application of statistical measures to vital events that is utilized to gauge the levels of health, illness and health services of a community HEALTH INDICATORS a list of information which would determine the health of a particular community like population, crude birth rate, crude death rate, infant and maternal death rates, neonatal death rates and tuberculosis death rate Health Indicators Birth

Death Marriages Migration

COMMON VITAL STATISTICAL INDICATORS Fertility Rates Crude Birth Rate

Number of livebirths in a year

Midyear Population, same year because of availability of data Used often

X 1000

a. Measures how fast people are added to the population through birth b. Crude since it is related to the total population including men, children and elderly who are not capable of giving birth General Fertility Rate
year

Number of livebirths in a

X Midyear Population of women15-1000

44 years of age

a. More specific than CBR since births are related to the segment of the population deemed capable of giving birth b. In some countries, reproductive age groups is 15-49 years of age Age Specific Fertility Rate
Total Births to women age X years

=
years

Midyear Population of women age X

X 1000

a. Most accurate refinement in the study of fertility Mortality Rates Crude Deathof deaths in a Number Rate
year Midyear Population, same year

X 1000

a. Crude because death is affected by different factors b. Widely used because of availability of data

 Specific Mortality Rate

Number of deaths in specified group

Midyear Population, same year

X 1000

a. Made specific according to: Age Sex Occupation Education Exposure to risk factors Combination of the above b. More valid than CDR when comparing mortality experiences between group Cause-of-Death Rate
Number of deaths in specified cause

Midyear Population, a. same year since the denominator includes the whole Crude rate

X 1000

population b. Could be made specific by relating the deaths from a specific cause and group to the mid-year population of that specific group Infant Mortality Rate
No. of deaths under 1 yr of age

No. of Live births, same

X 1000

year

a. SENSITIVE INDEX of level of health in a community b. HIGH IMR means LOW LEVELS of health standards secondary to poor maternal and child health care, malnutrition, poor environmental sanitation or deficient health service delivery c. May be artificially lowered by improving the registration of births Neonatal Mortality Rate

No. of deaths among those under 28 days of age

X 1000

No. of Livebirths, same year

Post-neonatal Mortality Rate

No. of deaths due to pregnancy, delivery and puerperium

X 1000

Number of Live Births

Maternal Mortality Rate

No. of deaths due to pregnancy, delivery and puerperium

X 1000

Number of Live Births

a. Measures risk of dying from causes associated with childbirth b. Affected by: Maternal health practices Diagnostic ascertainment of maternal condition or cause of death Completeness of registration of birth Perinatal Mortality Rate

Fetal Deaths, 28 weeks & over of gestation + early neonatal deaths, 1 week of age in calendar year X

1000

Number of Live Births

Proportionate Mortality Rate

No. of deaths from particular cause Total deaths from all cause, same year

X 100

a. Used in ranking cause of death by magnitude of frequency b. Expressed in PERCENTAGE

Swaroops Index

No. of deaths among those 50 years & over Total Deaths, Same year

X 100

a. LOW INDEX implies that life expectancy is short

b. Directly proportional to the health status of a population, where developed countries have higher Swaroops Index than developing countries Case Fatality Rate

No. of deaths from a specified cause No. of cases of the same disease

X 100

a. Measures the killing power of a disease or injury b. A HIGH CFR means a more fatal disease c. Rate depends on: Nature of the disease Diagnostic ascertainment Level of reporting in the population d. CFR from hospitals HIGHER than from the community Morbidity Rates Incidence Rate

No. of NEW CASES of disease developing from a period of time

X 100,000

Population in the area during the same period of time

a. Measures the development of a disease in a group exposed to the risk of the disease in a period of time b. Can be made specific for age and sex Attack Rate
No. of NEW CASES of disease developing from a period of time Population at risk of developing the disease during the same period of time

X 100

a. Used for a limited population group and time period, usually during an outbreak or epidemic

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

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

X 100

Population examined during that time

B. Period Prevalence
No. of existing (Old and New Cases) of a disease at a given interval time

X 100

Population examined during that interval time

INTERPRETATION OF VITAL STATISTICS Sources of Data Vital Registration Records a. Civil Registry Law or Republic Act No. 3753 requires the registration of all births and death c/o National Census and Statistics Office
b. PD 651 requires all health workers to register births within 30

days following delivery

Weekly Reports from Field Health Personnel Population Censuses done every 5 years c/o the National Census and Statistics Office

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

Part 14 Epidemiology
EPIDEMIOLOGY the study of distribution of disease or physiologic conditions such as deformities or disabilities and even death among human populations, and the factors affecting such distribution

AIM: to identify factors of causation as basis for determining preventive and control measures DESCRIPTIVE PHASE deals with the collection, organization, and analysis of data regarding the occurrence of disease other health conditions A. VERIFICATION OF A DIAGNOSIS -stating ones definition of a disease/ diagnosis based on the presenting signs and symptoms Consider Two Factors: 1. Sensitivity indicates the strength of association between a sign/ symptom and the disease; picks up most cases and avoids FALSE NEGATIVES 2. Specificity shows the uniqueness of the association between a sign/ symptom and the disease; excludes non cases or avoids FALSE POSITIVES B. DESCRIPTION OF THE DISEASE/ CONDITION Factors affecting distribution: 1. Place extrinsic factors 2. Person intrinsic characteristics such as age, sex, genetic endowment and other factors such as occupation, place of residence, income are analyzed to identify susceptible groups in a certain locality Factors Affecting the Communitys Reaction to Disease Agent Invasion a. Herd Immunity state of resistance of a population group to a particular disease at a given time; level of immunity of the group b. Susceptibility Status determined by the number of individuals with little or no immunity

Patterns of Disease Occurrence i. Epidemic - a situation when there is a high incidence of new cases of a specific disease in excess of the expected

ii. Endemic habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptible iii. Sporadic disease occurs every now and then affecting only a small number of people relative to the total population iv. Pandemic global occurrence of a disease
3. Time temporal patterns; expressed on a daily, weekly,

monthly or yearly basis C. ANALYSIS OF DISEASE PATTERN -one tries to find out if there is a statistical relationship between a disease and biological or social factors

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

Part 15 Demography

A. DEMOGRAPHY The empirical, statistical and mathematical study of human population; derived from two Greek word snyos, which means people and ypagly which means to draw or write Focuses on three common and observable human events: a. Population composition or structure b. Distribution of population in space c. Population size

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

Number of females

X 100

b. Age- dependency Ratio used as an index of age-induced No. of persons 0-14 years old + No. of persons aged 65 years and over

economic drain on human resources

X 1000

No. of persons 15-64 years old c. Age and Sex Composition graphical presentation of the age

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

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

above which 50% of the population fall.

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

is expected to live under the mortality conditions for a given year 2. Population Distribution a. Urban Rural Distribution shows the proportion of people living in urban compared to the rural areas
b. Crowding Index indicates the ease by which a communicable

disease can be transmitted from one host to another susceptible host

c. Population Density determines congestion of the place

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

of a specific population within a specified time

Part 16 Target Setting

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

calculating the number of children entering first grade in one year

3. Pregnant Women All pregnant women are eligible for EPI. Target

Setting must include the number of pregnancies that will terminate in live births (3% of the total population) plus the number of the pregnancies (0.5% of the total population); thus, the percentage of eligible women in the total population is 3.5% B. Calculating Vaccine Needs *How to Calculate Vaccine Needs Step One : Determine the eligible population Step Two: Determine the number of doses required in a year by multiplying the eligible population with the number of doses for complete immunization
ANNUAL DOSES NEEDED = Eligible population X No.

Step Three: Determine the wastage rate of antigen or use the wastage multiplier. From step two, multiply the product with the wastage multiplier to get the annual needs including the wastage allowance
ANNUAL DOSES WITH WASTAGE ALLOWANCE = Eligible population X No. of Doses X Wastage Multiplier

Step Four: Determine the number of ampoules or vials needed by dividing the annual dose by the dose per vial or ampule
ANNUAL VACCINE NEEDS PER VIAL DOSE = Annual Vaccine / Dose per

Step Five: Determine the vaccine need per month or quarter

MONTHLY VACCINE NEEDS = Total Vials or ampules / 12 months QUARTERLY VACCINE NEEDS = Total Vials or ampules / 4 quarters

Step Six: Determine the vaccine need per month or quarter with reserve stock
MONTHLY VACCINE NEEDS = (Total Vials or ampoules / 12 months) X 1.25

C. Determining Needle and Syringe Requirements *How to Calculate Needle and Syringe Requirements Step One: Determine the eligible population Step Two: Determine the monthly eligible population
MONTHLY ELIGIBLE POPULATION = Annual eligible population / 12 months

Step Three: Multiply the monthly eligible population by the number of doses required for each antigen
MONTHLY INJECTIONS = Monthly eligible population X doses required per antigen

Step Four: Determine the total requirement including additional allowance for syringes and needles
TOTAL REQUIRED SYRINGES = Monthly injections X 1.25 for syringes

TOTAL REQUIRED NEEDLES = Monthly injections X 1.50 for needles

Part 17 Environmental Sanitation

ENVIRONMENTAL SANITATION -is defined as the study of all factors in mans physical environment which may exercise a deleterious effect on his health, well-being and survival GOAL: to eradicate and control environmental factors in disease transmission through the provision of basic services and facilities to all house holds COMPONENTS: Water Supply Sanitation Program Proper Excreta and Sewage Disposal Program Insect and Rodent Control Food Sanitation Program Hospital Waste Management Program Strategies on Health Risk Minimization due to Environmental Pollution A. Water Supply Sanitation Program Three Types of Approved Water Supply and Facilities Level I Level II Level III Point Source Communal Faucet Waterworks System or System or Stand Posts Individual House Connections A protected well A system composed of a A system with a source, a or a developed source, a reservoir, a reservoir, a piped spring with an piped distribution network distributor network and outlet but without and communal faucets, household taps that is a distribution located at not more than suited for densely system for rural 25 meters from the populated urban areas areas where farthest house in rural houses are thinly areas where houses are scattered clustered densely B. Proper Excreta and Sewage Disposal Program Three Types of Approved Toilet Facilities Level 1 Non- water carriage Level 2 On site toilet facilities of Level 3 Water carriage types of

toilet facility

the water carriage type with water sealed and flushed type with septic vault/ tank disposal facilities

toilet facilities connected to septic tanks and/or sewerage system to a treatment plant

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

GOAL: to prevent the risk of contracting nosocomial infection and other diseases from the disposal of infectious, pathological and other hospital wastes Policies: 1. The use of appropriate technology and indigenous materials for HWM system shall be adopted 2. Training of all hospital personnel involved in waste management shall be an essential part of the hospital training program 3. Local ordinances regarding the collection and disposal techniques, especially incinerators, shall be institutionalized F. Strategies on Health Risk Minimization due to Environmental Pollution These include the following: a. Anti-smoke belching campaign and air pollution campaign b. Zero solid waste management c. Toxic, chemical and hazardous waste management d. Red tide control and monitoring e. Integrated pest management and sustainable agriculture f. Pasig river rehabilitation Management

Part 18 DOH National Events

FIRST QUARTER January 17Cancer Consciousness 23 Week February 16Leprosy control week 22 Heart Month Dental Health Month Campaign on Family Planning March 24 World TB day Womens Health Month Burn Injury Prevention Month Rabies Awareness Month
Colon and Rectal Cancer Awareness Month

23

DOH anniversary Kidney Month No Smoking Month Dengue Awareness Month

Prostate Cancer Awareness Month

July 1824

National Diabetes Awareness Week

Nutrition Month
National Voluntary Blood Donation Month

National Disaster Preparedness Month

SECOND QUARTER April 7 World Health Day

Cancer in Children Awareness Month

May 9-15 Safe Motherhood Week 23Health Workplace Week

29

31

World No Tobacco Day Natural Family Planning Month

Cervical Cancer Awareness Month

June 5 World Environment Day International Blood Donors 14

Day

THIRD QUARTER August 1 Family Planning Day 1-17 Mother-Baby Friendly Week 6-12 National Hospital Week 8-14 Asthma Attack 19 National TB Day National Lung Month Sight-Saving Month Lung Cancer Awareness Month September 26 World Heart Day Liver Cancer Awareness Month Generics Awareness Month FOURTH QUARTER October 1-7 Elderly Filipino Week

3-9 3-9 1016 1723 1723

National Mental Health Week National Newborn Screening Week Health Education Week

Osteoporosis Awareness Week Food Safety Awareness Week Breast Cancer Awareness Month National Childrens Month November 7 Food Fortification Day 7-13 Substance Abuse Prevention Week 14 World Diabetes Day 17 COPD Awareness Day
Traditional & Alternative Health Care Month

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