HISTORY OF CHN

• 1901 - Act # 157 ( Board of Health of thePhilippines) ; Act # 309 ( Provincial and
Municipal Boards of Health) were created.
• 1905 - Board of Health was abolished; functions were transferred to the Bureau of Health.
• 1912 – Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners of
present MHOs; male nurses performs the functions of doctors
• 1919 – Act # 2808 (Nurses Law was created)- Carmen del Rosario , 1st Fil. Nurse
supervisor under Bureau of Health
• Oct. 22, 1922 – Filipino Nurses Organization (Philippine Nurses’ Organization) was
organized.
• 1923 – Zamboanga General Hospital School of Nursing & Baguio General Hospital were
established; other government schools of nursing were organized several years after.
• 1928- 1st Nursing convention was held
• 1940 – Manila Health Department was created.
• 1941 – Dr. Mariano Icasiano became the first city health officer; Office of Nursing was
created through the effort of Vicenta Ponce (chief nurse) and Rosario Ordiz (assistant
chief nurse)
• Dec. 8, 1941 – Victims of World War II were treated by the nurses of Manila.
• July 1942 – Nursing Office was created; Dr. Eusebio Aguilar helped in the release of 31
Filipino nurses in Bilibid Prison as prisoners of war by the Japanese.
• Feb. 1946 – Number of nurses decreased from 556 – 308.
• 1948 – First training center of the Bureau of Health was organized by the Pasay City
Health Department. Trinidad Gomez, Marcela Gabatin, Costancia Tuazon, Ms. Bugarin, Ms.
Ramos, and Zenaida Nisce composed the training staff.
• 1950 – Rural Health Demonstration and Training Center was created.
• 1953 – The first 81 rural health units were organized.
• 1957 – RA 1891 amended some sections of RA 1082 and created the eight categories of
rural health unit causing an increase in the demand for the community health personnel.
• 1958-1965 – Division of Nursing was abolished (RA 977) and Reorganization Act (EO 288)
• 1961 – Annie Sand organized the National League of Nurses of DOH.
• 1967 – Zenaida Nisce became the nursing program supervisor and consultant on the six
special diseases (TB, leprosy, V.D., cancer, filariasis, and mental health illness).
• 1975 – Scope of responsibility of nurses and midwives became wider due to restructuring
of the health care delivery system.
• 1976-1986 – The need for Rural Health Practice Program was implemented.
• 1990- 1992- Local Government Code of 1991 (RA 7160)
• 1993-1998 – Office of Nursing did not materialize in spite of persistent recommendation
of the officers, board members, and advisers of the National League of Nurses
Inc.
• Jan. 1999 – Nelia Hizon was positioned as the nursing adviser at the Office of Public Health
Services through Department Order # 29.
• May 24, 1999 – EO # 102, which redirects the functions and operations of DOH, was
signed by former President Joseph Estrada.

LAWS AFFECTING PUBLIC HEALTH AND PRACTICE OF COMMUNITY HEALTH NURSING

R.A. 7160 - or the Local Government Code. This involves the devolution of powers, functions and
responsibilities to the local government both rural & urban.The Code aims to transform local
government units into self-reliant communities and active partners in the attainment of national
goals thru’ a more responsive and accountable local government structure instituted thru’ a
system of decentralization. Hence, each province, city and municipality has a LOCAL HEALTH
BOARD ( LHB ) which is mandated to propose annual budgetary allocations for the operation and
maintenance of their own health facilities.

Composition of LHB
Provincial Level
1.Governor- chair
2. Provincial Health Officer – vice chair
3. Chair , Committee on Health of Sangguniang
Panlalawigan
4. DOH rep.
5. NGO rep.

City and Municipal Level

1. Mayor – chair 4. DOH Representative
2. MHO – vice chair 5. NGO Representative
3. Chair, Committee on Health of Sangguniang Bayan
• R.A. 2382 – Philippine Medical Act. This act defines the practice of medicine in the country.
• R.A. 1082 – Rural Health Act. It created the 1st 81 Rural Health Units; amended by RA 1891
; more physicians, dentists, nurses, midwives and sanitary inspectors will live in the rural
areas where they are assigned in order to raise the health conditions of barrio people
,hence help decrease the high incidence of preventable diseases
• R.A. 6425 – Dangerous Drugs Act. It stipulates that the sale, administration, delivery,
distribution and transportation of prohibited drugs is punishable by law.
• R.A. 9165 – the new Dangerous Drug Act of 2002
• P.D. No. 651 – requires that all health workers shall identify and encourage the registration
of all births within 30 days following delivery.
• P.D. No. 996 – requires the compulsory immunization of all children below 8 yrs. of age
against the 6 childhood immunizable diseases.
• P.D. No. 825 – provides penalty for improper disposal of garbage.
• R.A. 8749 – Clean Air Act of 2000
• P.D. No. 856 – Code on Sanitation. It provides for the control of all factors in man’s
environment that affect health including the quality of water, food, milk, insects, animal
carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution and
control of nuisance.
• R.A. 6758 – standardizes the salary of government employees including the nursing
personnel.
• R.A. 6675 – Generics Act of 1988 which promotes, requires and ensures the production of
an adequate supply, distribution, use and acceptance of drugs and medicines identified by
their generic name.
• R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees. It is
the policy of the state to promote high standards of ethics in public office. Public officials
and employees shall at all times be accountable to the people and shall discharges their
duties with utmost responsibility, integrity, competence and loyalty, act with patriotism
and justice, lead modest lives uphold public interest over personal interest.
• R.A. 7305 – Magna Carta for Public Health Workers. This act aims: to promote and improve
the social and economic well-being of health workers, their living and working conditions
and terms of employment; to develop their skills and capabilities in order that they will be
more responsive and better equipped to deliver health projects and programs; and to
encourage those with proper qualifications and excellent abilities to join and remain in
government service.
• R.A. 8423 – created the Philippine Institute of Traditional and Alternative Health Care.
• P.D. No. 965 – requires applicants for marriage license to receive instructions on family
planning and responsible parenthood.
• P.D. NO. 79 – defines , objectives, duties and functions of POPCOM
• RA 4073 – advocates home treatment for leprosy
• Letter of Instruction No. 949 – legal basis of PHC dated OCT. 19, 1979; promotes
development of health programs on the community level
• RA 3573 – requires reporting of all cases of communicable diseases and administration of
prophylaxis
• Ministry Circular No. 2 of 1986 – includes AIDS as notifiable disease
• R.A. 7875 – National Health Insurance Act
• R.A. 7432 – Senior Citizens Act
• R. A. 7719 - National Blood Services Act
• R.A. 8172 – Salt Iodization Act ( ASIN LAW)
• R.A. 7277- Magna Carta for PWD’s, provides their rehabilitation, self-development and
self-reliance and integration into the mainstream of society
• A. O. No. 2005-0014- National Policies on Infant and Young Child Feeding:
1.All newborns be breastfeed within 1 hr after birth
2. Infants be exclusively breastfeed for 6 mos.
3. Infants be given timely, adequate and safe complementary foods
4. Breastfeeding be continued up to 2 years and beyond
• EO 51- Phil. Code of Marketing of Breastmilk Substitutes
• R.A.- 7600 – Rooming In and Breastfeeding Act of 1992
• R.A. 8976- Food Fortification Law
• A..O. No. 2006- 0015- defines the Implementing guidelines on Hepatitis B Immunization
for Infants
• R.A. 7846- mandates Compulsory Hepatitis B Immunization among infants and children
less than 8 yrs old
 • R.A. 2029- madates Liver Cancer and Hepatitis B Awareness Month Act ( February)

Concepts:
• The primary focus of community health nursing is health promotion.
• Community health nurses provide care necessary to meet the requirements of an
individual all throughout the life cycle.
• Knowledge on different fields (biological and social sciences, clinical nursing, and
community health organizations) is used.
• Nursing process in community health nursing changes based on the needs of the
community.
Goal:
• To elevate the level health of the multitude.
Philosophy
• Worth and dignity of man.
Principles
1. The need of the community is the basis of community health nursing.
2. The community health nurse must understand fully the objectives and policies of the
agency she represents.
3. The family is the unit of service.
4. CHN must be available to all regardless of race,creed and socioeconomic status
5. The CHN works as a member of the health team
6. There must be provision for periodic evaluation of community health nursing services
7. Opportunities for continuing staff education programs for nurses must be provided by the
community health nursing agency and the CHN as well
8. The CHN makes use of available community health resources
9. The CHN taps the already existing active organized groups in the community
10. There must be provision for educative supervision in community health nursing
11. There should be accurate recording and reporting in community health nursing
12.Health teaching is the primary responsibility of the community health nurse

ROLES AND FUNCTION OF THE PHN

The PHN has various roles spelled out in the law and the standards prescribed by the DOH and
different nursing associations.
The PHN can only perform his/her functions effectively if she/he:
a. has the necessary knowledge, skills, and attitudes in dealing with the health needs and
problems of his/her clients;
b. is familiar with the structure and dynamics of the health care system and its broader
socio-cultural, economic, and political context;
c. is knowledgeable of laws and policies affecting the health care system in general and
nursing practice in particular and of nursing and program standards.

NURSING LAW
Section 28 of RA 9173 (Philippine Nursing Act of 2002)
Scope of nursing:
A person shall be deemed to be practicing nursing …when he/she singly or in collaboration with
another, initiates and performs nursing services to individuals, families and
communities in any health care setting.

LEVELS OF CARE/ PREVENTION

1. PRIMARY LEVEL
Health services offered at this level are to individuals in fair health and to patients
with diseases in the early symptomatic stage.
2. SECONDARY LEVEL
Services offered to patients with symptomatic stages of disease which require
moderately specialized knowledge and technical resources for adequate treatment.
3. TERTIARY LEVEL
Services rendered at this level are for clients afflicted with diseases which seriously
threaten their health and which require highly technical and specialized knowledge,
facilities, and personnel to treat effectively.

Types of Clientele
1. INDIVIDUALS
2. FAMILIES
3. COMMUNITIES
4. POPULATION GROUPS
 - Aggregate of people who share common characteristics, developmental stage or
common exposure to particular environmental factors thus resulting in common health
problems ( Clark, 1995:5) e.g. children . elderly, women, workers etc.

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM

THE DEPARTMENT OF HEALTH

VISION: Health for all Filipinos
MISSION: Ensure accessibility & quality of health care to improve the quality of life of
all Filipinos, especially the poor.

NATIONAL OBJECTIVES
1. Improve the general health status of the population (reduce infant mortality rate, reduce
child morality rate, reduce maternal mortality rate, reduce total fertility rate, increase life
expectancy & the quality of life years).
2. Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B,
Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases,
Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic
Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, Iron Deficiency Anemia &
Obesity.
3. Eliminate the ff. diseases as public health problems:
  Schistosomiasis
 Malaria
 Filariasis
 Leprosy
 Rabies
 Measles
 Tetanus
 Diphtheria & Pertussis
 Vitamin A Deficiency & Iodine Deficiency Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness,
personal hygiene, mental health & less stressful life & prevent violent & risk-taking
behaviors.
6. Promote the health & nutrition of families & special populations through child, adolescent
& youth, adult health, women’s health, health of older persons, health of indigenous
people, health of migrant workers and health of different disabled persons and of the rural
& urban poor.
7. Promote environmental health and sustainable development through the promotion and
maintenance of healthy homes, schools, workplaces, establishments and communities
towns and cities.

Basic Principles to Achieve Improvement in Health

1. Universal access to basic health services must be ensured.
2. The health and nutrition of vulnerable groups must be prioritized.
3. The epidemiological shift from infection to degenerative diseases must be managed.
4. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals

1. Increasing investment for Primary Health Care.
2. Development of national standards and objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. Support for frontline health workers.

COMMUNITY HEALTH NURSING

- is a unique blend of nursing and public health practice woven into a human service that
properly developed and applied, has a tremendous impact on human well-being.
- is a service rendered by a professional nurse with the community, groups, families, and
individuals at home, in health centers, in clinics, in schools and in places of work for the
promotion of health.

PUBLIC HEALTH – the 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 dses, 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 the social machinery to ensure a standard of living adequate for the
maintenance of health, so organizing these benefits as to enable every citizen to realize his
birthright of health and longevity. (Dr. C.E. Winslow)

PRIMARY HEALTH CARE (PHC)

• May 1977 -30th World Health Assembly decided that the main health target of the
government and WHO is the attainment of a level of health that would permit them to lead
a socially and economically productive life by the year 2000.
• September 6-12, 1978 - First International Conference on PHC in Alma Ata, Russia (USSR)
The Alma Ata Declaration stated that PHC was the key to attain the “health for all” goal

October 19, 1979 - Letter of Instruction (LOI) 949), the legal basis of PHC was signed by
Pres. Ferdinand E. Marcos,
which adopted PHC as an approach towards the design, development and implementation of
programs focusing on health development at community level.

RATIONALE FOR ADOPTING PRIMARY HEALTH CARE:

• Magnitude of Health Problems
• Inadequate and unequal distribution of health resources
• Increasing cost of medical care
 • Isolation of health care activities from other development activities

DEFINITION OF PRIMARY HEALTH CARE

 essential health care made universally accessible to individuals and families in the
community by means acceptable to them, through their full participation and at cost that
the community can afford at every stage of development.
 a practical approach to making health benefits within the reach of all people.
 an approach to health development, which is carried out through a set of activities and
whose ultimate aim is the continuous improvement and maintenance of health status of
the community.

GOAL OF PRIMARY HEALTH CARE:

HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE
by the year 2020.
An improved state of health and quality of life for all people attained through SELF-RELIANCE.

B KEY STRATEGY TO ACHIEVE THE GOAL:

Partnership with and Empowerment of the people - permeate as 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.Ï

OBJECTIVES OF PRIMARY HEALTH CARE

• · Improvement in the level of health care of the community
• · Favorable population growth structure
• · Reduction in the prevalence of preventable, communicable and other disease.
• · Reduction in morbidity and mortality rates especially among infants and children.
• · Extension of essential health services with priority given to the underserved sectors.
• · Improvement in Basic Sanitation
• · Development of the capability of the community aimed at self-reliance.
• · Maximizing the contribution of the other sectors for the social and economic
development of the community.

MISSION:
To strengthen the health care system by increasing opportunities and supporting the
conditions wherein people will manage their own health care.

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS

1. Barangay Health Workers - trained community health workers or health auxiliary
volunteers or traditional birth attendants or healers.
2. Intermediate level health workers include the Public Health Nurse, Rural Sanitary Inspector
and midwives.

PRINCIPLES OF PRIMARY HEALTH CARE

1. 4 A's = Accessibility, Availability, Affordability & Acceptability, Appropriateness of
health services.
The health services should be present where the supposed recipients are. They should
make use of the available resources within the community, wherein the focus would be
more on health promotion and prevention of illness.
2. COMMUNITY PARTICIPATION =heart and soul of PHC
3. People are the center, object and subject of development.
 Thus, the success of any undertaking that aims at serving the people is dependent on
people’s participation at all levels of decision-making; planning, implementing, monitoring
and evaluating. Any undertaking must also be based on the people’s needs and problems
(PCF, 1990)
 Part of the people’s participation is the partnership between the community and the
agencies found in the community; social mobilization and decentralization.
 In general, health work should start from where the people are and building on what they
have. Example: Scheduling of Barangay Health Workers in the health center
BARRIERS OF COMMUNITY INVOLVEMENT
• Lack of motivation
• Attitude
• Resistance to change
• Dependence on the part of community people
 • Lack of managerial skills
4. SELF-RELIANCE
5. Partnership between the community and the health agencies in the provision of
quality of life.
Providing linkages between the government and the non-government organization and
people’s organization.
6. Recognition of interrelationship between the health and development

HEALTH
 is not merely the absence of disease. Neither it is only a state of physical and mental
well-being. Health being a social phenomenon recognizes the interplay of political, socio-
cultural and economic factors as its determinant. Good Health therefore, is manifested by
the progressive improvements in the living conditions and quality of life enjoyed by the
community residents (PCF, DEVELOPMENT is the quest for an improved quality of life for
all. Development is multi-dimensional. It has a political, social, cultural, institutional and
environmental dimensions(Gonzales 1994). Therefore, it is measured by the ability of
people to satisfy their basic needs.
7. SOCIAL MOBILIZATION
It enhances people participation or governance, support system provided by the
Government, networking and developing secondary leaders.

8. DECENTRALIZATION

ELEMENTS/COMPONENTS of PHC
- Education for Health
- Locally Endemic Disease Control
- Expanded Program on Immunization
- Maternal and Child Health
- Essential Drugs and Elderly Care
- Nutrition
- Treatment of CD and Non-CD
- Sanitation: Water and Environment

MAJOR STRATEGIES OF PRIMARY HEALTH CARE

A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL EFFORTS.
Attaining Health for all Filipino will require expanding participation in health and
health related programs whether as service provider or beneficiary. Empowerment to
parents, families and communities to make decisions of their health is really the desired
outcome.
Advocacy must be directed to National and Local policy making to elicit support
and commitment to major health concerns through legislations, budgetary and logistical
considerations.
B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE
The health in the hands of the people brings the government closest to the people.
It necessitates a process of capacity building of communities and organization to plan,
implement and evaluate health programs at their levels.
C. INCREASING EFFICIENCIES IN THE HEALTH SECTOR
Using appropriate technology will make services and resources required for their
delivery, effective, affordable, accessible and culturally acceptable. The development of
human resources must correspond to the actual needs of the nation and the policies it
upholds such as PHC. The DOH will continue to support and assist both public and private
institutions particularly in faculty development, enhancement of relevant curricula and
development of standard teaching materials.

D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH

Essential National Health Research (ENHR) is an integrated strategy for organizing
and managing research using intersectoral, multi-disciplinary and scientific approach to
health programming and delivery.

FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE

1. Active Community Participation
 2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available

FAMILY CARE PLAN

 is the blueprint of the care that the nurse designs to systematically minimize or eliminate
the identified health and family nursing problems through explicitly formulated outcomes
of care (goals and objectives) and deliberately chosen set of interventions, resources, and
evaluation criteria, methods and tools.

Features : based on the concept of planning as a process.

1. The NCP focuses on actions which are designed to solve or minimize existing problem.
2. The NCP is a product of a deliberate systematic process.
3. The NCP, as with all other plans, relates to the future.
4. The NCP is based upon identified health and nursing problems.
5. The NCP is a means to an end, not an end in itself.
6. The NCPlanning is a continuous process, not a one-shot-deal.

STEPS IN DEVELOPING A FNCP :

1. The prioritized condition/s or problems;
2. The goals and objectives of nursing care;
3. The plan of interventions; and,
4. The plan for evaluating care

Family Coping Index

Purpose:
• To provide a basis for estimating the nursing needs of a particular family.

Health Care Need

A family health care need is present when:
1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in the family’s ability to cope.

Relation to Coping Nursing Need:

• COPING may be defined as dealing with problems associated with health care with reasonable success.
• When the family is unable to cope with one or another aspect of health care, it may be said to have a “coping
deficit”
Direction for Scaling
• Two parts of the Coping index:
1. A point on the scale
2. A justification statement
• The scale enables you to place the family in relation to their ability to cope with the nine areas of family nursing at
the time observed and as you would expect it to be in 3 months or at the time of discharge if nursing care were
provided. Coping capacity is rated from 1 (totally unable to manage this aspect of family care) to 5 (able to handle
this aspect of care without help from community sources). Check “no problem” if the particular category is not
relevant to the situation.
• The justification consists of brief statement or phrases that explain why you have rated the family as you have.

General Considerations
1. It is the coping capacity and not the underlying problem that is being rated.
2. It is the family and not the individual that is being rated.
3. Rating should be done after 2-3 home visits when the nurse is more acquainted with the family.
4. The scale is as follows:
o 0-2 or no competence
o 3-5 coping in some fashion but poorly
o 6-8 moderately competent
o 9 fairly competent
5. Justification- a brief statement that explains why you have rated the family as you have. These statements should
be expressed in terms of behavior of observable facts. Example: “Family nutrition includes basic 4 rather than
good diet.
6. Terminal rating is done at the end of the given period of time. This enables the nurse to see progress the family
has made in their competence; whether the prognosis was reasonable; and whether the family needs further
nursing service and where emphasis should be placed.

Scaling Cues
• The following descriptive statements are “cues” to help you as you rate family coping. They are limited to three
points – 1 or no competence, 3 for moderate competence and 5 for complete competence.
Areas to Be Assessed
1. Physical independence: This category is concerned with the ability to move about to get out of bed, to take care
of daily grooming, walking and other things which involves the daily activities.
2. Therapeutic Competence: This category includes all the procedures or treatment prescribed for the care of ill,
such as giving medication, dressings, exercise and relaxation, special diets.
3. Knowledge of Health Condition: This system is concerned with the particular health condition that is the
occasion of care
4. Application of the Principles of General Hygiene: This is concerned with the family action in relation to
maintaining family nutrition, securing adequate rest and relaxation for family members, carrying out accepted
preventive measures, such as immunization.
5. Health Attitudes: This category is concerned with the way the family feels about health care in general, including
preventive services, care of illness and public health measures.
6. Emotional Competence: This category has to do with the maturity and integrity with which the members of the
family are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living.
7. Family Living: This category is concerned largely with the interpersonal with the interpersonal or group aspects
of family life – how well the members of the family get along with one another, the ways in which they take
decisions affecting the family as a whole.
8. Physical Environment: This is concerned with the home, the community and the work environment as it affects
family health.
9. Use of Community Facilities: generally keeps appointments. Follows through referrals. Tells others about
Health Departments services